Healthcare Provider Details

I. General information

NPI: 1528726064
Provider Name (Legal Business Name): KOLTON RILEY BUER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 12/01/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10610 SHAWNEE MISSION PKWY STE 210
SHAWNEE KS
66203-3501
US

IV. Provider business mailing address

3017 MCGEE ST
KANSAS CITY MO
64108-3232
US

V. Phone/Fax

Practice location:
  • Phone: 913-248-9500
  • Fax:
Mailing address:
  • Phone: 316-680-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number01-06148
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: