Provider Demographics
NPI:1700941564
Name:HUSS, MARY A (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:HUSS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 N BELT
Mailing Address - Street 2:STE I
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-279-1300
Mailing Address - Fax:816-279-0302
Practice Address - Street 1:3007 N BELT
Practice Address - Street 2:STE I
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-279-1300
Practice Address - Fax:816-279-0302
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODRC004909111N00000X
KS0104883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11103011OtherBCBS
10001231600OtherCHP
KS11103011OtherBCBS