Healthcare Provider Details

I. General information

NPI: 1790624070
Provider Name (Legal Business Name): JUSTIN FORKPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 WYOMING ST
KANSAS CITY MO
64111-3948
US

IV. Provider business mailing address

3810 WYOMING ST
KANSAS CITY MO
64111-3948
US

V. Phone/Fax

Practice location:
  • Phone: 816-206-7074
  • Fax:
Mailing address:
  • Phone: 816-206-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: