Provider Demographics
NPI:1194919282
Name:EXCELSIOR CHIROPRACTIC CENTER, PC
Entity type:Organization
Organization Name:EXCELSIOR CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:INA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:816-620-6211
Mailing Address - Street 1:1000 N JESSE JAMES RD STE 3
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1244
Mailing Address - Country:US
Mailing Address - Phone:816-620-6211
Mailing Address - Fax:816-630-6211
Practice Address - Street 1:1000 N JESSE JAMES RD STE 3
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1244
Practice Address - Country:US
Practice Address - Phone:816-620-6211
Practice Address - Fax:816-630-6211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12330037OtherBLUE CROSS BLUE SHIELD OF
MO4412828OtherAETNA
MO2032917OtherCIGNA
MO4400182OtherUNITED HEALTH CARE
MOT73784OtherHUMANA
MOT78406OtherUPIN
KS532434OtherBCBS KS
MOP00058846OtherRRMEDC
MOT78406OtherUPIN