Provider Demographics
NPI:1821219700
Name:BOTTORFF, DOUGLAS J
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:J
Last Name:BOTTORFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 ROCKHILL RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1124
Mailing Address - Country:US
Mailing Address - Phone:816-363-2222
Mailing Address - Fax:
Practice Address - Street 1:6301 ROCKHILL RD
Practice Address - Street 2:SUITE 312
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1124
Practice Address - Country:US
Practice Address - Phone:816-363-2222
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
MO005547111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO15604013OtherBLUE CROSS BLUE SHEILD