Provider Demographics
NPI:1548703846
Name:KCCORECASSCOUNTY LLC
Entity type:Organization
Organization Name:KCCORECASSCOUNTY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-282-6268
Mailing Address - Street 1:2820 E ROCK HAVEN RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-4411
Mailing Address - Country:US
Mailing Address - Phone:816-884-2440
Mailing Address - Fax:816-884-2445
Practice Address - Street 1:2820 E ROCK HAVEN RD
Practice Address - Street 2:SUITE 170
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-4411
Practice Address - Country:US
Practice Address - Phone:816-884-2440
Practice Address - Fax:816-884-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013035181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty