Provider Demographics
NPI:1043544281
Name:OTTIS FAMILY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:OTTIS FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:OTTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-741-8422
Mailing Address - Street 1:6449 N COSBY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2378
Mailing Address - Country:US
Mailing Address - Phone:816-741-8422
Mailing Address - Fax:816-741-8423
Practice Address - Street 1:6449 N COSBY AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2378
Practice Address - Country:US
Practice Address - Phone:816-741-8422
Practice Address - Fax:816-741-8423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009005935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty