Provider Demographics
NPI:1194046789
Name:ALPHA CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:ALPHA CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:L.
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-531-1211
Mailing Address - Street 1:1807 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-4401
Mailing Address - Country:US
Mailing Address - Phone:816-531-1211
Mailing Address - Fax:816-531-1211
Practice Address - Street 1:1807 W 39TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-4401
Practice Address - Country:US
Practice Address - Phone:816-531-1211
Practice Address - Fax:816-531-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10755017OtherBCBS
MO10755017OtherBCBS