MEDICARE: MIDTOWN HEALTH CENTER, LLC

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	111NS0005X	Sports Physician Chiropractor	5908	MO

General Provider Information

NPI Number	:	1386873735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDTOWN HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	3406 BROADWAY ST
Second Line	:	SUITE A
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2404
Country	:	US
Telephone Number	:	816-531-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3406 BROADWAY ST
Second Line	:	SUITE A
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2404
Country	:	US
Telephone Number	:	816-531-3300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEN D ALEXANDER
Credential	:	DC
Telephone Number	:	816-531-3300

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	07/08/2009

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