Provider Demographics
NPI:1235564899
Name:EXCEL SPINE SPORT AND PERFORMANCE LLC
Entity Type:Organization
Organization Name:EXCEL SPINE SPORT AND PERFORMANCE LLC
Other - Org Name:KC CHIRO AND INSIDE SPORTS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:LIGON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-888-4845
Mailing Address - Street 1:8550 MARSHALL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214
Mailing Address - Country:US
Mailing Address - Phone:913-888-4845
Mailing Address - Fax:913-888-9248
Practice Address - Street 1:8550 MARSHALL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214
Practice Address - Country:US
Practice Address - Phone:913-888-4845
Practice Address - Fax:913-888-9248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty