Provider Demographics
NPI:1528312659
Name:LEES SUMMIT FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:LEES SUMMIT FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-694-7623
Mailing Address - Street 1:618 SW 3RD ST
Mailing Address - Street 2:UNIT H
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2277
Mailing Address - Country:US
Mailing Address - Phone:816-694-7623
Mailing Address - Fax:
Practice Address - Street 1:618 SW 3RD ST
Practice Address - Street 2:UNIT H
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2277
Practice Address - Country:US
Practice Address - Phone:816-694-7623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011041270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4245001Medicare UPIN
MOMA4245Medicare PIN