Healthcare Provider Details

I. General information

NPI: 1235321001
Provider Name (Legal Business Name): KANSAS CITY CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 BELLEVIEW AVE SUITE L12
KANSAS CITY MO
64112-1378
US

IV. Provider business mailing address

4700 BELLEVIEW AVE SUITE L12
KANSAS CITY MO
64112-1378
US

V. Phone/Fax

Practice location:
  • Phone: 816-753-4600
  • Fax: 816-753-4620
Mailing address:
  • Phone: 816-753-4600
  • Fax: 816-753-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2002030424
License Number StateMO

VIII. Authorized Official

Name: DR. LYNN L MCINTOSH
Title or Position: LICENSED PROFESSIONAL CHIROPRACTOR
Credential: D.C.
Phone: 816-753-4600