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General NPI Number Information
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NPI Number | 1679055115
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Entity Type | Organization
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Legal Business Name | ISOM CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 07/02/2022
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Provider Practice Location Address
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Address Line | 10942 W 74TH TER
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City | SHAWNEE
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State | KS
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Zip | 66203-4420
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Country | US
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Telephone | 913-735-9565
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Fax | 913-273-0009
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Provider Business Mailing Address
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Address Line | 8145 RENNER RD APT 3
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City | LENEXA
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State | KS
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Zip | 66219-8012
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Country | US
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Telephone | 913-735-9565
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Fax | 913-273-0009
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. JOSHUA MICHAERL ISOM
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Credential | DC
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Telephone | 913-735-9565
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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 | 01-05696
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License Number State | KS
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