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General NPI Number Information
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NPI Number | 1801950589
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Entity Type | Organization
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Legal Business Name | BROOKSIDE HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 7337 BROADWAY ST
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City | KANSAS CITY
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State | MO
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Zip | 64114-1357
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Country | US
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Telephone | 816-523-4600
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Fax | 816-523-4724
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Provider Business Mailing Address
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Address Line | 7337 BROADWAY ST
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City | KANSAS CITY
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State | MO
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Zip | 64114-1357
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Country | US
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Telephone | 816-523-4600
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Fax | 816-523-4724
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL KELLY MILLER
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Credential | DC
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Telephone | 816-523-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 004675
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2006023685
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | R5D43
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License Number State | MO
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