Provider Demographics
NPI:1942502653
Name:SCANLON, KEVIN ANDREW (DC, BS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANDREW
Last Name:SCANLON
Suffix:
Gender:M
Credentials:DC, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4307 BLUE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-2026
Mailing Address - Country:US
Mailing Address - Phone:816-401-7282
Mailing Address - Fax:816-867-4555
Practice Address - Street 1:4307 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-2026
Practice Address - Country:US
Practice Address - Phone:816-401-7282
Practice Address - Fax:816-867-4555
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010 042 410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO45402028OtherBCBS- KCMO