=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184763096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHY BODY CHIROPRACTIC, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 635 E 23RD ST S
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055-1504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-836-3000
-----------------------------------------------------
Fax | 816-836-3001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 635 E 23RD ST S
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055-1504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-836-3000
-----------------------------------------------------
Fax | 816-836-3001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. SHAWNA LYNN EVANS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 816-836-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------