Provider Demographics
NPI:1841219664
Name:COFFMAN, KEVIN SHAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SHAWN
Last Name:COFFMAN
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 1:6009 NW 68TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1611
Mailing Address - Country:US
Mailing Address - Phone:816-741-3800
Mailing Address - Fax:816-741-1537
Practice Address - Street 1:6009 NW 68TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-1611
Practice Address - Country:US
Practice Address - Phone:816-741-3800
Practice Address - Fax:816-741-1537
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO05111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO29442011OtherBLUE SHIELD KANSAS CITY
KS458250OtherBLUE SHIELD KANSAS
MO000A731Medicare PIN