Provider Demographics
NPI:1750979365
Name:KANSAS CITY HEALTH & WELLNESS CLINIC, LLC
Entity type:Organization
Organization Name:KANSAS CITY HEALTH & WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANNISE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NATHANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-806-2757
Mailing Address - Street 1:11902 BLUE RIDGE EXT STE O
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1199
Mailing Address - Country:US
Mailing Address - Phone:816-808-9900
Mailing Address - Fax:913-273-0081
Practice Address - Street 1:11902 BLUE RIDGE EXT STE O
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1199
Practice Address - Country:US
Practice Address - Phone:816-808-9900
Practice Address - Fax:913-273-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty