Provider Demographics
NPI:1376744474
Name:DR YENNIE CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:DR YENNIE CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:YENNIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DIPL AC (NCCAOM)
Authorized Official - Phone:816-931-0287
Mailing Address - Street 1:4140 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111
Mailing Address - Country:US
Mailing Address - Phone:816-931-0287
Mailing Address - Fax:816-931-2127
Practice Address - Street 1:4140 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2617
Practice Address - Country:US
Practice Address - Phone:816-931-0287
Practice Address - Fax:816-931-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO05689018OtherBLUE CROSS BLUE SHIELD
MO05689018OtherBLUE CROSS BLUE SHIELD