Provider Demographics
NPI:1245308212
Name:DUSENBERY, KATHY LYNNE (DC)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:LYNNE
Last Name:DUSENBERY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 NW 66TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2374
Mailing Address - Country:US
Mailing Address - Phone:816-587-3711
Mailing Address - Fax:
Practice Address - Street 1:5905 NW 66TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2374
Practice Address - Country:US
Practice Address - Phone:816-587-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166716111N00000X
NE1245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOBO30952OtherPHCS
MO30952014OtherBCBS
MO7907233OtherAETNA
MO7907233OtherAETNA
U84125Medicare UPIN