Provider Demographics
NPI:1497995393
Name:RESTORE MUSCLE AND JOINT, LLC
Entity Type:Organization
Organization Name:RESTORE MUSCLE AND JOINT, LLC
Other - Org Name:PEARSON CHIROPRACTIC AND ACUPUNCTURE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-452-4488
Mailing Address - Street 1:5601 NE ANTIOCH RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2302
Mailing Address - Country:US
Mailing Address - Phone:816-452-4488
Mailing Address - Fax:816-452-4491
Practice Address - Street 1:5601 NE ANTIOCH RD STE 4
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-2328
Practice Address - Country:US
Practice Address - Phone:816-452-4488
Practice Address - Fax:816-452-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS77D856Medicare PIN