Provider Demographics
NPI:1659592327
Name:GUTSHALL, DENNIS L (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:GUTSHALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 EMANUEL CLEAVER II BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-2368
Mailing Address - Country:US
Mailing Address - Phone:816-923-0500
Mailing Address - Fax:
Practice Address - Street 1:4501 EMANUEL CLEAVER II BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-2368
Practice Address - Country:US
Practice Address - Phone:816-923-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0004059AMedicare ID - Type Unspecified