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General NPI Number Information
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NPI Number | 1871865550
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Entity Type | Organization
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Legal Business Name | NORTHLAND SPINE AND REHABILITATION, LLC
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 8002 N OAK TRFY SUITE 112
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City | KANSAS CITY
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State | MO
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Zip | 64118-1268
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Country | US
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Telephone | 816-569-5079
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Fax | 816-569-5298
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Provider Business Mailing Address
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Address Line | 8002 N OAK TRFY SUITE 112
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City | KANSAS CITY
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State | MO
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Zip | 64118-1268
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Country | US
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Telephone | 816-569-5079
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Fax | 816-569-5298
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Authorized Official
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Title or Position | OWNER
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Name | DR. BLAKE MITCHELL OVERLY
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Credential | D.C.
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Telephone | 816-569-5079
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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 | 2009013598
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License Number State | MO
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