Provider Demographics
NPI:1235596982
Name:LEE'S SUMMIT CHIROPRACTIC CENTER P.C.
Entity Type:Organization
Organization Name:LEE'S SUMMIT CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:JORDANE
Authorized Official - Last Name:VIFQUAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-804-0202
Mailing Address - Street 1:319 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2333
Mailing Address - Country:US
Mailing Address - Phone:816-524-7000
Mailing Address - Fax:816-524-6993
Practice Address - Street 1:319 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2333
Practice Address - Country:US
Practice Address - Phone:816-524-7000
Practice Address - Fax:816-524-6993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111N00000X, 111NS0005X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty