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General NPI Number Information
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NPI Number | 1720443294
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Entity Type | Organization
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Legal Business Name | PURE MOTION CHIROPRACTIC & REHAB, LLC
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 12/28/2015
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Provider Practice Location Address
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Address Line | 15945 W 65TH ST
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City | SHAWNEE
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State | KS
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Zip | 66217-9342
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Country | US
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Telephone | 316-249-5555
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Fax | 316-219-6341
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Provider Business Mailing Address
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Address Line | 11641 W 118TH TER APT. 736
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City | OVERLAND PARK
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State | KS
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Zip | 66210-2047
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Country | US
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Telephone | 316-249-5555
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Fax | 316-219-3641
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Authorized Official
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Title or Position | DC/OWNER
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Name | DUSTIN MOSES
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Credential | DC
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Telephone | 316-249-5555
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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 | 01-05707
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License Number State | KS
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