Provider Demographics
NPI:1679071138
Name:KANSAS CITY FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:KANSAS CITY FAMILY CHIROPRACTIC CENTER
Other - Org Name:KCFCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:POTERBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-382-5586
Mailing Address - Street 1:13404 HOLMES RD STE A
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64145-1446
Mailing Address - Country:US
Mailing Address - Phone:816-382-5586
Mailing Address - Fax:
Practice Address - Street 1:13404A HOLMES RD STE A
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1446
Practice Address - Country:US
Practice Address - Phone:816-382-5586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012032774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty