MEDICARE: ARCKCMO 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619465945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCKCMO LLC

Provider Business Mailing Address
First Line	:	4609 PASEO BLVD STE 100
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64110-1843
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4609 PASEO BLVD STE 100
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64110-1843
Country	:	US
Telephone Number	:	913-424-0324
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. THAYER BANWART
Credential	:
Telephone Number	:	816-779-1022

Provider Enumeration Date	:	04/23/2018
Last Update Date	:	12/05/2022

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Directions to “ARCKCMO LLC ” Practice Location

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