Provider Demographics
NPI:1629196803
Name:PAGE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PAGE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-867-2026
Mailing Address - Street 1:1436 W AA HWY
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-0619
Mailing Address - Country:US
Mailing Address - Phone:816-867-2026
Mailing Address - Fax:816-867-2029
Practice Address - Street 1:1436 W AA HWY
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-0619
Practice Address - Country:US
Practice Address - Phone:816-867-2026
Practice Address - Fax:816-867-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999137888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO33076011OtherBLUE CROSS BLUE SHIELD
MOQ120000Medicare ID - Type Unspecified