Provider Demographics
NPI:1235274408
Name:PROSAK, DARWIN M (DC)
Entity Type:Individual
Prefix:DR
First Name:DARWIN
Middle Name:M
Last Name:PROSAK
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 1:222 W GREGORY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1127
Mailing Address - Country:US
Mailing Address - Phone:816-523-3585
Mailing Address - Fax:
Practice Address - Street 1:222 W GREGORY BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1127
Practice Address - Country:US
Practice Address - Phone:816-523-3585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12906012OtherBLUE CROSS
MO0005631Medicare ID - Type Unspecified