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General NPI Number Information
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NPI Number | 1245480615
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Entity Type | Organization
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Legal Business Name | NATURAL WAY CHIROPRACTIC CENTER OF LEE'S SUMMIT, LLC
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 1186 NE DOUGLAS ST
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City | LEES SUMMIT
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State | MO
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Zip | 64086-4602
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Country | US
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Telephone | 816-525-9393
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Fax | 816-525-9385
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Provider Business Mailing Address
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Address Line | 1186 NE DOUGLAS ST
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City | LEES SUMMIT
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State | MO
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Zip | 64086-4602
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Country | US
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Telephone | 816-525-9393
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Fax | 816-525-9385
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. SHANE LOUIS OLIVERIUS
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Credential | D.C.
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Telephone | 816-525-9393
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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 | 2007038067
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License Number State | MO
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