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NPI Code Detail

MEDICARE: THRIVE KC, LLC

MEDICARE: THRIVE KC, 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
1111N00000XChiropractor0105832KS

General Provider Information

NPI Number : 1881117265
Entity Type Code : Organization
Provider Name (Legal Business Name) : THRIVE KC, LLC
Provider Business Mailing Address
First Line : 13601 KING ST APT 727
Second Line :
City : OVERLAND PARK
State : KS
Zip : 66221-8186
Country : US
Telephone Number : 913-957-9360
Fax Number :
Provider Business Practice Location Address
First Line : 8016 STATE LINE RD STE 100
Second Line :
City : PRAIRIE VILLAGE
State : KS
Zip : 66208-3713
Country : US
Telephone Number : 913-735-6854
Fax Number : 913-273-6617
Authorized Official
Title or Position : OWNER/CHIROPRACTOR
Name : DR. BETHANY LONG
Credential : DC
Telephone Number : 913-957-9360
Provider Enumeration Date : 07/18/2017
Last Update Date : 07/18/2017

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Directions to “THRIVE KC, LLC ” Practice Location

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