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General NPI Number Information
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NPI Number | 1588103972
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Entity Type | Organization
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Legal Business Name | GRANDVIEW CHIROPRACTIC & ACUPUNCTURE CLINIC LLC
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 12121 BLUE RIDGE BLVD SUITE O
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City | GRANDVIEW
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State | MO
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Zip | 64030-6401
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Country | US
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Telephone | 816-217-0020
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Fax |
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Provider Business Mailing Address
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Address Line | 12121 BLUE RIDGE EXT STE A
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City | GRANDVIEW
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State | MO
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Zip | 64030-1103
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Country | US
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Telephone | 816-217-0020
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Fax |
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Authorized Official
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Title or Position | OWNER, DOCTOR
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Name | KYUNGHWAN AN
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Credential | D.C.
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Telephone | 816-217-0020
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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 | 2013013772
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License Number State | MO
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