=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881858520
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERESA FEBBO DC CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2008
-----------------------------------------------------
Last Update Date | 07/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6908 NW BARRY RD
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64153-1764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-741-8663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6908 NW BARRY RD
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64153-1764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-741-8663
-----------------------------------------------------
Fax | 816-584-0149
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC
-----------------------------------------------------
Name | MS. THERESA A FEBBO
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 816-741-8663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 005847
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------