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NPI Code Detail

MEDICARE: OM CHIROPRACTIC LLC

MEDICARE: OM CHIROPRACTIC 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
1111N00000XChiropractor2014010985MO

General Provider Information

NPI Number : 1992180186
Entity Type Code : Organization
Provider Name (Legal Business Name) : OM CHIROPRACTIC LLC
Provider Business Mailing Address
First Line : 4149 PENNSYLVANIA AVE
Second Line : SUITE 201
City : KANSAS CITY
State : MO
Zip : 64111-3087
Country : US
Telephone Number : 816-561-1185
Fax Number :
Provider Business Practice Location Address
First Line : 4149 PENNSYLVANIA AVE
Second Line : SUITE 201
City : KANSAS CITY
State : MO
Zip : 64111-3087
Country : US
Telephone Number : 816-561-1185
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. JAIMIE L MCCORMICK
Credential : D.C.
Telephone Number : 816-561-1185
Provider Enumeration Date : 07/29/2015
Last Update Date : 07/29/2015

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Directions to “OM CHIROPRACTIC LLC ” Practice Location

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