Healthcare Provider Details

I. General information

NPI: 1710511357
Provider Name (Legal Business Name): KYLE JAMES KOERNER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2020
Last Update Date: 02/22/2020
Certification Date: 02/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19600 E 39TH ST S
INDEPENDENCE MO
64057-2301
US

IV. Provider business mailing address

11010 DELAWARE PKWY APT 3104
KANSAS CITY KS
66109-3586
US

V. Phone/Fax

Practice location:
  • Phone: 816-795-5300
  • Fax:
Mailing address:
  • Phone: 316-323-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2020005290
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2020005290
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: