Provider Demographics
NPI:1073669917
Name:JOHN, EMILIO A (DC, MS)
Entity Type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:A
Last Name:JOHN
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15545 W. 87TH ST. PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219
Mailing Address - Country:US
Mailing Address - Phone:913-894-0770
Mailing Address - Fax:913-894-4427
Practice Address - Street 1:15545 W. 87TH ST. PARKWAY
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219
Practice Address - Country:US
Practice Address - Phone:913-894-0770
Practice Address - Fax:913-894-4427
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-3994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2360489OtherAETNA
KS495978OtherBC KS
KS15671030OtherBLUE CROSS BLUE SHIELD KC
KS44-08041OtherUHC
KS143961OtherCOVENTRY
KST042499Medicare ID - Type UnspecifiedMEDICARE NUMBER
KSU11867Medicare UPIN