Healthcare Provider Details

I. General information

NPI: 1982979167
Provider Name (Legal Business Name): ABSOLUTELY CHIROPRACTIC & ACUPUNCTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E STONE ST
INDEPENDENCE MO
64050-4664
US

IV. Provider business mailing address

921 E STONE ST
INDEPENDENCE MO
64050-4664
US

V. Phone/Fax

Practice location:
  • Phone: 816-204-8509
  • Fax: 816-836-4289
Mailing address:
  • Phone: 816-204-8509
  • Fax: 816-836-4289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2000144181
License Number StateMO

VIII. Authorized Official

Name: DR. SHAWNA LYNN EVANS
Title or Position: PRESIDENT/OWNER
Credential: DC
Phone: 816-204-8509