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General NPI Number Information
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NPI Number | 1548509581
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Entity Type | Organization
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Legal Business Name | LIVING BALANCE CHIROPRACTIC & ACUPUNCTURE
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Dates
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Enumeration Date | 02/12/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 5910 NW 63RD TER
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City | KANSAS CITY
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State | MO
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Zip | 64151-3319
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Country | US
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Telephone | 816-216-1218
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Fax | 816-216-1633
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Provider Business Mailing Address
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Address Line | 5910 NW 63RD TER
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City | KANSAS CITY
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State | MO
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Zip | 64151-3319
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Country | US
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Telephone | 816-216-1218
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Fax | 816-216-1633
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA HICKMAN
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Credential | DC
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Telephone | 816-863-7177
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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 | 20103004098
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License Number State | MO
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