Healthcare Provider Details

I. General information

NPI: 1316138316
Provider Name (Legal Business Name): MYOCORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 LEE'S SUMMIT RD
KANSAS CITY MO
64139-1246
US

IV. Provider business mailing address

601 SE MELODY LN
LEES SUMMIT MO
64063-4804
US

V. Phone/Fax

Practice location:
  • Phone: 630-229-4430
  • Fax: 630-229-4430
Mailing address:
  • Phone: 816-219-1977
  • Fax: 816-434-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2007035558
License Number StateMO

VIII. Authorized Official

Name: JASON MOSS
Title or Position: DC
Credential: DC
Phone: 630-229-4430