Healthcare Provider Details

I. General information

NPI: 1942677109
Provider Name (Legal Business Name): CHASE JORDANE VIFQUAIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
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: 816-524-0168
Mailing address:
  • Phone: 816-524-7000
  • Fax: 816-524-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2015024930
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: