Northland Spine and Rehabilitation, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2009013598 Issued in MO

Legal business name

NORTHLAND SPINE AND REHABILITATION, LLC

Practice address

8002 N Oak Trfy
Suite 112
Kansas City, MO 64118-1268

Phone

(816) 569-5079

Fax

(816) 569-5298

NPI assigned

Jan 27, 2012

Last updated

Jan 27, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Blake Mitchell Overly, D.C.NPI 1134356637

Title

Owner

Phone

(816) 569-5079

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Blake Overly, DC

  • Chiropractor
  • Kansas City, MO
  • NPI 1134356637
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1327622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327622400000",
    "number": "1871865550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8002 N OAK TRFY",
            "address_2": "SUITE 112",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641181268",
            "telephone_number": "816-569-5079",
            "fax_number": "816-569-5298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8002 N OAK TRFY",
            "address_2": "SUITE 112",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641181268",
            "telephone_number": "816-569-5079",
            "fax_number": "816-569-5298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAND SPINE AND REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-27",
        "last_updated": "2012-01-27",
        "status": "A",
        "authorized_official_last_name": "OVERLY",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_middle_name": "MITCHELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-569-5079",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2009013598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northland Orthopedics & Sports Medicine, LLC
• Northland Psychiatric Specialists LLC
• Northland Psychiatry LLC
• Northland Radiology, Inc.
• Northland Rehabilitation & Health Care Center LLC (Northland Rehabilitation & Health Care Center)
• Northland Wellness Center Inc
• Northland Women's Health Care, P.C.
• Ryan Northup, M.D.
• Northwest Regional Youth Center
• Northwoods Chiropractic PC

• Chiropractor in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.