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General NPI Number Information
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NPI Number | 1306853098
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Entity Type | Individual
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Provider Name | JAY P SPORTSMAN DC
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3715 N OAK TRAFFICWAY
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City | KANSAS CITY
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State | MO
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Zip | 64116
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Country | US
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Telephone | 816-455-1414
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Fax | 816-455-8343
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Provider Business Mailing Address
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Address Line | 6453 N AMORET AVE
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City | KANSAS CITY
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State | MO
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Zip | 64151
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Country | US
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Telephone | 816-507-4613
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Fax | 816-455-8343
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2002032135
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License Number State | MO
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