MEDICARE: DR. MICHAEL OWEN KIRSE D.C.

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	005472	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13739021	OTHER	MO	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1588691307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL OWEN KIRSE D.C.

Provider Business Mailing Address
First Line	:	PO BOX 6486
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-6486
Country	:	US
Telephone Number	:	816-525-5355
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 NE DOUGLAS ST
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-4610
Country	:	US
Telephone Number	:	816-525-5355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	07/08/2007

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