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General NPI Number Information
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NPI Number | 1528489887
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Entity Type | Organization
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Legal Business Name | JUSTIN BASHOR DC LLC
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 117 BRADFORD LN
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City | BELTON
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State | MO
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Zip | 64012-2086
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Country | US
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Telephone | 816-322-4900
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Fax | 816-322-4902
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Provider Business Mailing Address
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Address Line | 117 BRADFORD LN
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City | BELTON
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State | MO
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Zip | 64012-2086
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Country | US
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Telephone | 816-322-4900
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Fax | 816-322-4902
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Authorized Official
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Title or Position | OWNER - DC
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Name | JUSTIN BASHOR
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Credential | DC
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Telephone | 816-322-4900
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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 | 2012003540
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License Number State | MO
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