Healthcare Provider Details

I. General information

NPI: 1245153956
Provider Name (Legal Business Name): IVON GUADALUPE GARCIA FUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 HOLMES ST # 704
KANSAS CITY MO
64108-2602
US

IV. Provider business mailing address

601 SE MELODY LN
LEES SUMMIT MO
64063-4804
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-6489
  • Fax:
Mailing address:
  • Phone: 816-404-6489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2026035853
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: