Provider Demographics
NPI:1720443294
Name:PURE MOTION CHIROPRACTIC & REHAB, LLC
Entity Type:Organization
Organization Name:PURE MOTION CHIROPRACTIC & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-249-5555
Mailing Address - Street 1:11641 W 118TH TER
Mailing Address - Street 2:APT. 736
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2047
Mailing Address - Country:US
Mailing Address - Phone:316-249-5555
Mailing Address - Fax:316-219-3641
Practice Address - Street 1:15945 W 65TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9342
Practice Address - Country:US
Practice Address - Phone:316-249-5555
Practice Address - Fax:316-219-6341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty