Healthcare Provider Details

I. General information

NPI: 1497995393
Provider Name (Legal Business Name): RESTORE MUSCLE AND JOINT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 NE ANTIOCH RD STE 4
GLADSTONE MO
64119-2328
US

IV. Provider business mailing address

5601 NE ANTIOCH RD SUITE 8
GLADSTONE MO
64119-2302
US

V. Phone/Fax

Practice location:
  • Phone: 816-452-4488
  • Fax: 816-452-4491
Mailing address:
  • Phone: 816-452-4488
  • Fax: 816-452-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENDRA LYNN PEARSON
Title or Position: OWNER
Credential: DC
Phone: 816-452-4488