Provider Demographics
NPI:1437666187
Name:HUNTSUCKER, COREY BENNETT (LMT)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:BENNETT
Last Name:HUNTSUCKER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 N OAK TRFY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-2778
Mailing Address - Country:US
Mailing Address - Phone:816-500-2772
Mailing Address - Fax:
Practice Address - Street 1:3721 N OAK TRFY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-2778
Practice Address - Country:US
Practice Address - Phone:816-500-2772
Practice Address - Fax:816-500-2772
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011021592225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty