Dissociative Associates, LLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

DISSOCIATIVE ASSOCIATES, LLC

Practice address

817 NE Anderson LN
Lees Summit, MO 64064-1244

Phone

(816) 381-2050

Fax

(816) 503-8271

NPI assigned

Dec 8, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert Fansler

Title

Office Manager

Phone

(816) 678-5969

Specialties & licenses 1

Addresses

Other names 1

• Ketamine Clinic RX Doing business as

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1316658495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 NE ANDERSON LN",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640641244",
            "telephone_number": "816-381-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 NE ANDERSON LN",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640641244",
            "telephone_number": "816-381-2050",
            "fax_number": "816-503-8271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISSOCIATIVE ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-08",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "FANSLER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "816-678-5969"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@ketamineclinicrx.com",
            "affiliation": "N",
            "address_1": "817 NE Anderson Ln",
            "city": "Lees Summit",
            "state": "MO",
            "country_code": "US",
            "postal_code": "640641244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Ketamine Clinic RX",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael J. Dieker, R.PH.
• Nicole Marie Anna Dierking, D.C.
• Kylie B Digiacinto, CRNA
• John Dimaggio, D.C., M.S.
• Carl E Dippel, LCMFT
• Krishna Manej Divadeenam, MD
• Diversity Placement Services, Inc.
• Andrea Louise Dixon, MA, LPC
• April S Dixon, LPC
• Misty Dawn Dixon, LCSW

• All providers in Lees Summit, MO
• Infusion Therapy Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.