Provider Demographics
NPI:1336211713
Name:MIDWEST CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MIDWEST CHIROPRACTIC PC
Other - Org Name:MIDWEST CHIROPRACTIC AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-229-6633
Mailing Address - Street 1:1416 NW STATE ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2238
Mailing Address - Country:US
Mailing Address - Phone:816-229-6633
Mailing Address - Fax:816-229-6295
Practice Address - Street 1:1416 NW STATE ROUTE 7
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2238
Practice Address - Country:US
Practice Address - Phone:816-229-6633
Practice Address - Fax:816-229-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
35386018OtherBCBS KC GROUP NUMBER
S780000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER