Provider Demographics
NPI:1528489887
Name:JUSTIN BASHOR DC LLC
Entity type:Organization
Organization Name:JUSTIN BASHOR DC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER - DC
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-322-4900
Mailing Address - Street 1:117 BRADFORD LN
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-2086
Mailing Address - Country:US
Mailing Address - Phone:816-322-4900
Mailing Address - Fax:816-322-4902
Practice Address - Street 1:117 BRADFORD LN
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2086
Practice Address - Country:US
Practice Address - Phone:816-322-4900
Practice Address - Fax:816-322-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012003540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty