Healthcare Provider Details

I. General information

NPI: 1518112002
Provider Name (Legal Business Name): SHAREN KAUZLARICH DC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 SW NOEL ST
LEES SUMMIT MO
64063-2241
US

IV. Provider business mailing address

PO BOX 72
LEES SUMMIT MO
64063-0072
US

V. Phone/Fax

Practice location:
  • Phone: 816-809-3263
  • Fax: 816-524-3262
Mailing address:
  • Phone: 816-809-3269
  • Fax: 816-524-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number006538
License Number StateMO

VIII. Authorized Official

Name: DR. SHAREN KAY KAUZLARICH
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 816-809-3263