=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922301563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CASEY CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2010
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6443 N COSBY AVE
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64151-2378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-584-0413
-----------------------------------------------------
Fax | 816-584-0453
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6443 N COSBY AVE
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64151-2378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-584-0413
-----------------------------------------------------
Fax | 816-584-0453
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | DR. PETER D. CASEY
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 816-584-0413
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2010030918
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------