Healthcare Provider Details

I. General information

NPI: 1912649971
Provider Name (Legal Business Name): GLADSTONE CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7626 N OAK TRFY
KANSAS CITY MO
64118-1751
US

IV. Provider business mailing address

7626 N OAK TRFY
KANSAS CITY MO
64118-1751
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-7636
  • Fax: 360-457-4221
Mailing address:
  • Phone: 360-452-7636
  • Fax: 360-457-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN JAROD CLARK
Title or Position: OWER
Credential: DC
Phone: 360-452-7636