Provider Demographics
NPI:1225257462
Name:BRENTWOOD FAMILY CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:BRENTWOOD FAMILY CHIROPRACTIC CENTER, LLC
Other - Org Name:BRENTWOOD FAMILY CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-647-3847
Mailing Address - Street 1:8079 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2817
Mailing Address - Country:US
Mailing Address - Phone:314-647-3847
Mailing Address - Fax:314-644-0449
Practice Address - Street 1:8079 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2817
Practice Address - Country:US
Practice Address - Phone:314-647-3847
Practice Address - Fax:314-644-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003077601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14722Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER