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General NPI Number Information
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NPI Number | 1679071138
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Entity Type | Organization
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Legal Business Name | KANSAS CITY FAMILY CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 01/30/2018
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Provider Practice Location Address
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Address Line | 13404A HOLMES RD STE A
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City | KANSAS CITY
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State | MO
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Zip | 64145-1446
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Country | US
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Telephone | 816-382-5586
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Fax |
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Provider Business Mailing Address
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Address Line | 13404 HOLMES RD STE A
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City | KANSAS CITY
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State | MO
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Zip | 64145-1446
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Country | US
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Telephone | 816-382-5586
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTIC PHYSICIAN
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Name | DR. TIFFANY POTERBIN
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Credential | DC
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Telephone | 816-382-5586
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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 | 2012032774
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License Number State | MO
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