Healthcare Provider Details

I. General information

NPI: 1871858472
Provider Name (Legal Business Name): RAINTREE CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 SW LEMANS LN
LEES SUMMIT MO
64082-4619
US

IV. Provider business mailing address

931 SW LEMANS LN
LEES SUMMIT MO
64082-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-623-3020
  • Fax: 816-623-3076
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2012030934
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2012015058
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2012013030
License Number StateMO

VIII. Authorized Official

Name: DR. TRAVIS T MOORE
Title or Position: OWNER
Credential: DC
Phone: 816-623-3020