Provider Demographics
NPI:1245480615
Name:NATURAL WAY CHIROPRACTIC CENTER OF LEE'S SUMMIT, LLC
Entity type:Organization
Organization Name:NATURAL WAY CHIROPRACTIC CENTER OF LEE'S SUMMIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:OLIVERIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-525-9393
Mailing Address - Street 1:1186 NE DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4602
Mailing Address - Country:US
Mailing Address - Phone:816-525-9393
Mailing Address - Fax:816-525-9385
Practice Address - Street 1:1186 NE DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4602
Practice Address - Country:US
Practice Address - Phone:816-525-9393
Practice Address - Fax:816-525-9385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATURAL WAY CHIROPRACTIC CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007038067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty