MEDICARE: CARL S CLEVELAND IV, DC 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	111N00000X	Chiropractor	01-05403	KS

General Provider Information

NPI Number	:	1578858270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARL S CLEVELAND IV, DC LLC

Provider Business Mailing Address
First Line	:	8016 STATE LINE
Second Line	:	STE 100
City	:	LEAWOOD
State	:	KS
Zip	:	66208
Country	:	US
Telephone Number	:	913-341-4300
Fax Number	:	913-341-4301

Provider Business Practice Location Address
First Line	:	8016 STATE LINE RD
Second Line	:	STE 100
City	:	LEAWOOD
State	:	KS
Zip	:	66208
Country	:	US
Telephone Number	:	913-341-4300
Fax Number	:	913-341-4301

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CARL S CLEVELAND IV
Credential	:
Telephone Number	:	913-341-4300

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	06/10/2011

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