Healthcare Provider Details

I. General information

NPI: 1376737668
Provider Name (Legal Business Name): ANDY MINOR, CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAIN ST
BLUE SPRINGS MO
64015-3707
US

IV. Provider business mailing address

801 W MAIN ST
BLUE SPRINGS MO
64015-3707
US

V. Phone/Fax

Practice location:
  • Phone: 816-228-5522
  • Fax: 816-220-0205
Mailing address:
  • Phone: 816-228-5522
  • Fax: 816-220-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2005001169
License Number StateMO

VIII. Authorized Official

Name: DR. ANDY LANE MINOR
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 816-228-5522