=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235730466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INLINE CHIROPRACTIC CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2020
-----------------------------------------------------
Last Update Date | 03/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 244 W MILL ST STE 105
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64068-2398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-857-2700
-----------------------------------------------------
Fax | 816-857-2701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 244 W MILL ST STE 105
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64068-2398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-857-2700
-----------------------------------------------------
Fax | 816-857-2701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / CHIROPRACTOR
-----------------------------------------------------
Name | DR. ERIC J BUCKLEY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 816-857-2700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------