Guernsey Chiropractic and Sports Injury Center LLC
Organization Active NPI Chiropractor · Bethany, MO
NPI 1609178185 · NPPES record last updated Aug 13, 2012
Key facts
- NPI
- 1609178185
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2010013285 (MO)
- Legal business name
- GUERNSEY CHIROPRACTIC AND SPORTS INJURY CENTER LLC
- Practice address
- 1704 Main St
Bethany, MO 64424-2064 - Phone
- (660) 425-3444
- Fax
- (660) 425-3044
- NPI assigned
- Dec 3, 2010
- Organization subpart
- No
Authorized official
- Name
- Tina Forman
- Title
- Office Manager
- Phone
- (660) 425-3444
Practitioners 2
-
Caleb Guernsey, CALEB GUERNSEY
-
Kelly Jay Kadolph, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110523000120 | MO | Part B Supplier - Clinic/Group Practice | 5991981276 |
Receives reassigned benefits from 1 practitioner Practice locations: Bethany, MO |
National Provider Directory
Locations
2302 Main St
Bethany, MO 64424
Phone (660) 425-3444
1704 Main St
Bethany, MO 64424
Phone (660) 425-3312
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 2010013285 | MO | Yes |
Addresses
Primary practice location
1704 Main St
Bethany, MO 64424-2064
Mailing address
1704 Main St
Bethany, MO 64424-2064
Phone (660) 425-3444
Other providers in Bethany, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.