Provider Demographics
NPI:1033426697
Name:DAVID B. SHUCK DO, LLC
Entity Type:Organization
Organization Name:DAVID B. SHUCK DO, LLC
Other - Org Name:BODYLOGICMD OF KANSAS CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:877-341-8075
Mailing Address - Street 1:14352 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2987
Mailing Address - Country:US
Mailing Address - Phone:877-341-8075
Mailing Address - Fax:
Practice Address - Street 1:14352 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2987
Practice Address - Country:US
Practice Address - Phone:877-341-8075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSO5-23677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty