Provider Demographics
NPI:1619465945
Name:ARCKCMO LLC
Entity Type:Organization
Organization Name:ARCKCMO LLC
Other - Org Name:ACCIDENT REHAB CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THAYER
Authorized Official - Middle Name:
Authorized Official - Last Name:BANWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-779-1022
Mailing Address - Street 1:4609 PASEO BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4609 PASEO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-1843
Practice Address - Country:US
Practice Address - Phone:913-424-0324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO230101972Medicaid