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General NPI Number Information
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NPI Number | 1699036897
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Entity Type | Individual
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Provider Name | BRANON SHADD MCMICHAEL B.S, D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 8335 N CONGRESS AVE
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City | KANSAS CITY
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State | MO
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Zip | 64152-2041
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Country | US
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Telephone | 816-741-4711
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Fax |
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Provider Business Mailing Address
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Address Line | 5008 S KENDALL DR
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City | INDEPENDENCE
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State | MO
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Zip | 64055-5349
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Country | US
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Telephone | 816-898-9633
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2012016891
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License Number State | MO
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