Provider Demographics
NPI:1992573349
Name:GUILLAUME, EMMANUELA (DC)
Entity type:Individual
Prefix:
First Name:EMMANUELA
Middle Name:
Last Name:GUILLAUME
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10517 HICKMAN MILLS DR APT 17
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1673
Mailing Address - Country:US
Mailing Address - Phone:816-536-6851
Mailing Address - Fax:
Practice Address - Street 1:17027 BEL RAY BLVD
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-5371
Practice Address - Country:US
Practice Address - Phone:816-425-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023041325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor