Healthcare Provider Details

I. General information

NPI: 1215655162
Provider Name (Legal Business Name): FIT MUSCLE & JOINT CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NW MURRAY RD
LEES SUMMIT MO
64081-1425
US

IV. Provider business mailing address

22120 MIDLAND DR STE 1
SHAWNEE KS
66226-3554
US

V. Phone/Fax

Practice location:
  • Phone: 816-944-4244
  • Fax:
Mailing address:
  • Phone: 913-745-4064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW MILLER LANE
Title or Position: OWNER
Credential: DC
Phone: 913-745-4064