=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427483536
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | F.I.T.T. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2013
-----------------------------------------------------
Last Update Date | 09/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 ARMOUR RD
-----------------------------------------------------
City | NORTH KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64116-3512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-889-9801
-----------------------------------------------------
Fax | 816-889-9802
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 ARMOUR RD
-----------------------------------------------------
City | NORTH KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64116-3512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-889-9801
-----------------------------------------------------
Fax | 816-889-9802
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JABAN M MOORE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 816-889-9801
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------