Provider Demographics
NPI:1558437525
Name:DOTY, JOHN D (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:DOTY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 BLUE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133
Mailing Address - Country:US
Mailing Address - Phone:816-373-9355
Mailing Address - Fax:
Practice Address - Street 1:4307 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-2026
Practice Address - Country:US
Practice Address - Phone:816-373-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0000331Medicare ID - Type Unspecified