Provider Demographics
NPI:1194711242
Name:NORTHWOODS CHIROPRACTIC PC
Entity type:Organization
Organization Name:NORTHWOODS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-454-2100
Mailing Address - Street 1:5748 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-3998
Mailing Address - Country:US
Mailing Address - Phone:816-454-2100
Mailing Address - Fax:816-454-2122
Practice Address - Street 1:5748 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-3998
Practice Address - Country:US
Practice Address - Phone:816-454-2100
Practice Address - Fax:816-454-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26500024OtherBC/BS
MO26500024OtherBC/BS
U77946Medicare UPIN