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General NPI Number Information
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NPI Number | 1265612063
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Entity Type | Organization
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Legal Business Name | RADIANT HEALTH CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 111 NW TEAKWOOD ST
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City | LEES SUMMIT
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State | MO
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Zip | 64064-1438
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Country | US
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Telephone | 816-350-0860
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Fax | 816-350-0860
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Provider Business Mailing Address
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Address Line | 111 NW TEAKWOOD ST
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City | LEES SUMMIT
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State | MO
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Zip | 64064-1438
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Country | US
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Telephone | 816-350-0860
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Fax | 816-350-0860
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. DAVID ALAN TRIBBLE
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Credential | D.C.
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Telephone | 816-350-0860
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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 | 4070
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License Number State | MO
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