MEDICARE: MR. GREGORY PAUL BAUSCH DOCTOR DC

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	006819	MO

General Provider Information

NPI Number	:	1871651729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY PAUL BAUSCH DOCTOR DC

Provider Business Mailing Address
First Line	:	4115 NORTH CHERRY STREET
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116
Country	:	US
Telephone Number	:	816-454-3993
Fax Number	:	816-454-3993

Provider Business Practice Location Address
First Line	:	4115 NORTH CHERRY STREET
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116
Country	:	US
Telephone Number	:	816-454-3993
Fax Number	:	816-454-3993

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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