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General NPI Number Information
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NPI Number | 1194711242
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Entity Type | Organization
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Legal Business Name | NORTHWOODS CHIROPRACTIC PC
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 5748 N BROADWAY ST
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City | KANSAS CITY
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State | MO
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Zip | 64118-3998
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Country | US
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Telephone | 816-454-2100
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Fax | 816-454-2122
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Provider Business Mailing Address
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Address Line | 5748 N BROADWAY ST
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City | KANSAS CITY
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State | MO
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Zip | 64118-3998
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Country | US
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Telephone | 816-454-2100
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Fax | 816-454-2122
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GERALD W WITT
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Credential | DC
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Telephone | 816-454-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 006792
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License Number State | MO
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