Healthcare Provider Details

I. General information

NPI: 1235596982
Provider Name (Legal Business Name): LEE'S SUMMIT CHIROPRACTIC CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 SE MAIN ST
LEES SUMMIT MO
64063-2333
US

IV. Provider business mailing address

319 SE MAIN ST
LEES SUMMIT MO
64063-2333
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-7000
  • Fax: 816-524-6993
Mailing address:
  • Phone: 816-524-7000
  • Fax: 816-524-6993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateMO

VIII. Authorized Official

Name: DR. CHASE JORDANE VIFQUAIN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 816-804-0202