Healthcare Provider Details

I. General information

NPI: 1821507591
Provider Name (Legal Business Name): JOSHUA GREENWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 SE BLUE PKWY
LEE'S SUMMIT MO
64063
US

IV. Provider business mailing address

7501 COLONIAL DR
PRAIRIE VILLAGE KS
66208-4652
US

V. Phone/Fax

Practice location:
  • Phone: 816-944-4244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2017033483
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: