MEDICARE: DR. JEREMY MICHAEL BULLIMORE 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	2009004813	MO
2	111N00000X	Chiropractor	0105229	KS

General Provider Information

NPI Number	:	1891935128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY MICHAEL BULLIMORE DC

Provider Business Mailing Address
First Line	:	2310 HOLMES ST
Second Line	:	SUITE 704
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2602
Country	:	US
Telephone Number	:	816-404-6489
Fax Number	:	816-404-6494

Provider Business Practice Location Address
First Line	:	2310 HOLMES ST
Second Line	:	SUITE 704
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2602
Country	:	US
Telephone Number	:	816-404-6489
Fax Number	:	816-404-6494

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

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	07/31/2012

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