Provider Demographics
NPI:1992180186
Name:OM CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:OM CHIROPRACTIC LLC
Other - Org Name:OM CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-561-1185
Mailing Address - Street 1:4149 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3087
Mailing Address - Country:US
Mailing Address - Phone:816-561-1185
Mailing Address - Fax:
Practice Address - Street 1:4149 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3087
Practice Address - Country:US
Practice Address - Phone:816-561-1185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014010985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty