Provider Demographics
NPI:1639344948
Name:LIBERTY PARK CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:LIBERTY PARK CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-407-7200
Mailing Address - Street 1:1508 NE 96TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1348
Mailing Address - Country:US
Mailing Address - Phone:816-407-7200
Mailing Address - Fax:816-407-7222
Practice Address - Street 1:1508 NE 96TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1348
Practice Address - Country:US
Practice Address - Phone:816-407-7200
Practice Address - Fax:816-407-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006008609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO40026012OtherBCBS
MOU83284Medicare UPIN
MO40026012OtherBCBS