Provider Demographics
NPI:1497870786
Name:BISAHA SMITH, MARY KATHERINE (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:BISAHA SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:B
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:6299 W 157TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3588
Mailing Address - Country:US
Mailing Address - Phone:816-809-4126
Mailing Address - Fax:913-912-5870
Practice Address - Street 1:9209 W 110TH ST BLDG 36
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1401
Practice Address - Country:US
Practice Address - Phone:913-648-8111
Practice Address - Fax:913-912-5870
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04499111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
5107103OtherAETNA
13449020OtherBCBS
0007216AMedicare ID - Type Unspecified
U17961Medicare UPIN