Provider Demographics
NPI:1508066432
Name:MICHAEL O. KIRSE, D.C., P.C.
Entity Type:Organization
Organization Name:MICHAEL O. KIRSE, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:KIRSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-525-5355
Mailing Address - Street 1:PO BOX 6486
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-6486
Mailing Address - Country:US
Mailing Address - Phone:816-525-5355
Mailing Address - Fax:
Practice Address - Street 1:1500 NE DOUGLAS ST STE C
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4614
Practice Address - Country:US
Practice Address - Phone:816-525-5355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE005472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP562236Medicare PIN
MOU05610Medicare UPIN