Provider Demographics
NPI:1619123197
Name:MIDWEST FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:MIDWEST FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:DUSENBERY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-587-3711
Mailing Address - Street 1:5905 N.W. 66TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2374
Mailing Address - Country:US
Mailing Address - Phone:816-587-3711
Mailing Address - Fax:
Practice Address - Street 1:5905 N.W. 66TH TERRACE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2374
Practice Address - Country:US
Practice Address - Phone:816-587-3711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200166716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOB030952OtherPCHS
MO30952014OtherBCBS
MO7907233OtherAETNA
MOU84125Medicare UPIN