MEDICARE: CENTER OF LIFE CHIROPRACTIC

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	2000173074	MO

General Provider Information

NPI Number	:	1376801902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER OF LIFE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	336 W 75TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-5739
Country	:	US
Telephone Number	:	816-361-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	336 W 75TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-5739
Country	:	US
Telephone Number	:	816-361-2225
Fax Number	:

Authorized Official
Title or Position	:	VISE PRESIDENT
Name	:	MR. DEVIN DEAN MCDONALD
Credential	:
Telephone Number	:	816-361-2225

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	05/02/2012

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Directions to “CENTER OF LIFE CHIROPRACTIC ” Practice Location

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