Provider Demographics
NPI:1720301088
Name:CORE CHIROPRACTIC CENTRE LLC
Entity Type:Organization
Organization Name:CORE CHIROPRACTIC CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-272-6000
Mailing Address - Street 1:3601 NE RALPH POWELL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2357
Mailing Address - Country:US
Mailing Address - Phone:816-272-6000
Mailing Address - Fax:816-272-6001
Practice Address - Street 1:3601 NE RALPH POWELL RD
Practice Address - Street 2:SUITE C
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2357
Practice Address - Country:US
Practice Address - Phone:816-272-6000
Practice Address - Fax:816-272-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO2001002825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU84047Medicare UPIN