Provider Demographics
NPI:1477070431
Name:KC WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:KC WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-694-1658
Mailing Address - Street 1:5812 N AMES AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2183
Mailing Address - Country:US
Mailing Address - Phone:816-694-1658
Mailing Address - Fax:816-841-4801
Practice Address - Street 1:5417 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205-2912
Practice Address - Country:US
Practice Address - Phone:816-841-4865
Practice Address - Fax:816-841-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center