Provider Demographics
NPI:1306853098
Name:SPORTSMAN, JAY P (DC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:P
Last Name:SPORTSMAN
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 1:6453 N AMORET AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151
Mailing Address - Country:US
Mailing Address - Phone:816-507-4613
Mailing Address - Fax:816-455-8343
Practice Address - Street 1:3715 N OAK TRAFFICWAY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116
Practice Address - Country:US
Practice Address - Phone:816-455-1414
Practice Address - Fax:816-455-8343
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002032135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO33601017OtherBCBS
V03785Medicare UPIN
MO000D622Medicare ID - Type Unspecified