Provider Demographics
NPI:1396250718
Name:CASEY, KOWIN K (DC, PT)
Entity type:Individual
Prefix:DR
First Name:KOWIN
Middle Name:K
Last Name:CASEY
Suffix:
Gender:M
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-1815
Mailing Address - Country:US
Mailing Address - Phone:913-424-2410
Mailing Address - Fax:913-491-7997
Practice Address - Street 1:1815 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-1815
Practice Address - Country:US
Practice Address - Phone:913-424-2410
Practice Address - Fax:913-491-7997
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05978111N00000X, 111NR0400X
MO2017039451111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician