=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245357482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELYN L GATES D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 229 NW BLUE PKWY SUITE C
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64063-1869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-554-6926
-----------------------------------------------------
Fax | 816-554-6927
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 229 NW BLUE PARKWAY SUITE C
-----------------------------------------------------
City | LEE'S SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-554-6926
-----------------------------------------------------
Fax | 816-554-6927
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 004087
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------