Provider Demographics
NPI:1104041631
Name:PLEASANT HILL CHIROPRACTIC
Entity Type:Organization
Organization Name:PLEASANT HILL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PIVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-540-8932
Mailing Address - Street 1:1805 N 7 HWY
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-9421
Mailing Address - Country:US
Mailing Address - Phone:816-540-8932
Mailing Address - Fax:816-540-8937
Practice Address - Street 1:1805 NORTH 7 HIGHWAY
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-1464
Practice Address - Country:US
Practice Address - Phone:816-540-8932
Practice Address - Fax:816-540-8937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003026730111N00000X
KS0104704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOX060000Medicare PIN