=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154314532
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL D PAGE D.C., D.A.C.R.B.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2005
-----------------------------------------------------
Last Update Date | 07/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14810 E 42ND ST S SUITE 100
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055-4775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-461-5113
-----------------------------------------------------
Fax | 816-836-0285
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14810 E 42ND ST S SUITE 100
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055-4775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-461-5113
-----------------------------------------------------
Fax | 816-836-0285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 003853
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------