Provider Demographics
NPI:1467200774
Name:CENTRAL DIVISION CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:CENTRAL DIVISION CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-301-4355
Mailing Address - Street 1:4049 PENNSYLVANIA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3022
Mailing Address - Country:US
Mailing Address - Phone:816-301-4355
Mailing Address - Fax:816-301-6193
Practice Address - Street 1:4049 PENNSYLVANIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3022
Practice Address - Country:US
Practice Address - Phone:816-301-4355
Practice Address - Fax:816-301-6193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty