Provider Demographics
NPI:1649799784
Name:CAREY, JOHN EDMUND IV (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDMUND
Last Name:CAREY
Suffix:IV
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:EDMUND
Other - Last Name:CAREY
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:7329 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7329 BROADWAY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1357
Practice Address - Country:US
Practice Address - Phone:816-547-8731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017032456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor