Provider Demographics
NPI:1265612063
Name:RADIANT HEALTH CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:RADIANT HEALTH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TRIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-350-0860
Mailing Address - Street 1:111 NW TEAKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1438
Mailing Address - Country:US
Mailing Address - Phone:816-350-0860
Mailing Address - Fax:816-350-0860
Practice Address - Street 1:111 NW TEAKWOOD ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1438
Practice Address - Country:US
Practice Address - Phone:816-350-0860
Practice Address - Fax:816-350-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
27115022OtherGROUP BCBS NUMBER
27116021OtherINDIVIDUAL BC/BS NUMBER
N640000Medicare PIN
T06463Medicare UPIN
27115022OtherGROUP BCBS NUMBER