Provider Demographics
NPI:1336220656
Name:CREATIVE WELLNESS CENTER
Entity Type:Organization
Organization Name:CREATIVE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC,ND
Authorized Official - Phone:816-942-4700
Mailing Address - Street 1:544 E 99TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4203
Mailing Address - Country:US
Mailing Address - Phone:816-942-4700
Mailing Address - Fax:
Practice Address - Street 1:544 E 99TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4203
Practice Address - Country:US
Practice Address - Phone:816-942-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006799111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NT0100XChiropractic ProvidersChiropractorThermographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000B397OtherMEDICARE LEGACY