Provider Demographics
NPI:1083154678
Name:KENT, JOHN LUCAS (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LUCAS
Last Name:KENT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4507 E 111TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-2436
Mailing Address - Country:US
Mailing Address - Phone:785-410-2794
Mailing Address - Fax:
Practice Address - Street 1:4507 E 111TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-2436
Practice Address - Country:US
Practice Address - Phone:785-410-2794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017003921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor