Provider Demographics
NPI:1164784179
Name:NORTHLAND CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:NORTHLAND CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:COSNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-587-4325
Mailing Address - Street 1:7211 NW 83RD ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-6022
Mailing Address - Country:US
Mailing Address - Phone:816-587-4325
Mailing Address - Fax:816-587-4337
Practice Address - Street 1:7211 NW 83RD ST
Practice Address - Street 2:SUITE 230
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152-6022
Practice Address - Country:US
Practice Address - Phone:816-587-4325
Practice Address - Fax:816-587-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1710052634Medicare UPIN
MO0006552Medicare PIN