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General NPI Number Information
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NPI Number | 1376801902
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Entity Type | Organization
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Legal Business Name | CENTER OF LIFE CHIROPRACTIC
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 336 W 75TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64114-5739
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Country | US
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Telephone | 816-361-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 336 W 75TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64114-5739
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Country | US
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Telephone | 816-361-2225
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Fax |
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Authorized Official
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Title or Position | VISE PRESIDENT
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Name | MR. DEVIN DEAN MCDONALD
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Credential |
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Telephone | 816-361-2225
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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 | 2000173074
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License Number State | MO
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