MEDICARE: CHIROPRACTIC WELLNESS CENTER 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	2005000397	MO

General Provider Information

NPI Number	:	1285829275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC WELLNESS CENTER PC

Provider Business Mailing Address
First Line	:	3611 MAIN ST STE 103
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-1932
Country	:	US
Telephone Number	:	816-561-7035
Fax Number	:	816-960-3890

Provider Business Practice Location Address
First Line	:	3611 MAIN ST STE 103
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-1932
Country	:	US
Telephone Number	:	816-561-7035
Fax Number	:	816-960-3890

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ELIZABETH L BLAIR
Credential	:	D.C.
Telephone Number	:	816-561-7035

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	08/09/2011

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