Provider Demographics
NPI:1194242438
Name:MIDTOWN MUSCLE AND JOINT LLC
Entity type:Organization
Organization Name:MIDTOWN MUSCLE AND JOINT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:LYNN CHARLES
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-381-0667
Mailing Address - Street 1:1610 W 41ST ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-4102
Mailing Address - Country:US
Mailing Address - Phone:913-515-5347
Mailing Address - Fax:
Practice Address - Street 1:1711 WESTPORT RD STE 1
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5201
Practice Address - Country:US
Practice Address - Phone:816-381-0667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015040816111N00000X
KS01-05757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831556836OtherPERSONAL NPI NUMBER
MO2015040816OtherSTATE LICENSE