Provider Demographics
NPI:1306909114
Name:MISSION CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MISSION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLITS
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:913-432-4780
Mailing Address - Street 1:6556 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2615
Mailing Address - Country:US
Mailing Address - Phone:913-432-4780
Mailing Address - Fax:913-262-2690
Practice Address - Street 1:6556 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2615
Practice Address - Country:US
Practice Address - Phone:913-432-4780
Practice Address - Fax:913-262-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS026223Medicare PIN