Healthcare Provider Details

I. General information

NPI: 1821219700
Provider Name (Legal Business Name): DR. DOUGLAS J BOTTORFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 ROCKHILL RD SUITE 312
KANSAS CITY MO
64131-1124
US

IV. Provider business mailing address

6301 ROCKHILL RD SUITE 312
KANSAS CITY MO
64131-1124
US

V. Phone/Fax

Practice location:
  • Phone: 816-363-2222
  • Fax:
Mailing address:
  • Phone: 816-363-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number005547
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: