MEDICARE: BARRY ROAD CHIROPRACTIC INC.

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	006699	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25154022	OTHER	MO	BLUE CROSSBLUE SHIELD LD
2	510881822	OTHER	MO	TAX ID USED WITH MOST INS

General Provider Information

NPI Number	:	1518083906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARRY ROAD CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	6316 NW BARRY RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-2531
Country	:	US
Telephone Number	:	816-505-1772
Fax Number	:	816-505-1599

Provider Business Practice Location Address
First Line	:	6316 NW BARRY RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-2531
Country	:	US
Telephone Number	:	816-505-1772
Fax Number	:	816-505-1599

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL R EMERY
Credential	:	D.C.
Telephone Number	:	816-505-1772

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	04/04/2019

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