Provider Demographics
NPI:1578503702
Name:PEARSON, KENDRA LYNN (DC)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:LYNN
Last Name:PEARSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:KENDRA
Other - Middle Name:LYNN
Other - Last Name:SLEYSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
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
Practice Address - Street 2:SUITE 8
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-2302
Practice Address - Country:US
Practice Address - Phone:816-452-4488
Practice Address - Fax:816-452-4491
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004022004111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34722021OtherBCBS
V05093Medicare UPIN
MOS77D856Medicare PIN