MEDICARE: NORTHWOODS CHIROPRACTIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	006792	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26500024	OTHER	MO	BC/BS

General Provider Information

NPI Number	:	1194711242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWOODS CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	5748 N BROADWAY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-3998
Country	:	US
Telephone Number	:	816-454-2100
Fax Number	:	816-454-2122

Provider Business Practice Location Address
First Line	:	5748 N BROADWAY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-3998
Country	:	US
Telephone Number	:	816-454-2100
Fax Number	:	816-454-2122

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GERALD W WITT
Credential	:	DC
Telephone Number	:	816-454-2100

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	07/14/2010

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