Provider Demographics
NPI:1710378088
Name:KC CORE ST-JOSEPH LLC
Entity Type:Organization
Organization Name:KC CORE ST-JOSEPH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:ELBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-673-8733
Mailing Address - Street 1:1010 CARONDELET DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4859
Mailing Address - Country:US
Mailing Address - Phone:816-404-9120
Mailing Address - Fax:
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:SUITE 204
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4859
Practice Address - Country:US
Practice Address - Phone:816-384-2300
Practice Address - Fax:816-384-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015000689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty