Provider Demographics
NPI:1578858270
Name:CARL S CLEVELAND IV, DC LLC
Entity Type:Organization
Organization Name:CARL S CLEVELAND IV, DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:913-341-4300
Mailing Address - Street 1:8016 STATE LINE
Mailing Address - Street 2:STE 100
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66208
Mailing Address - Country:US
Mailing Address - Phone:913-341-4300
Mailing Address - Fax:913-341-4301
Practice Address - Street 1:8016 STATE LINE RD
Practice Address - Street 2:STE 100
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66208
Practice Address - Country:US
Practice Address - Phone:913-341-4300
Practice Address - Fax:913-341-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty