Provider Demographics
NPI:1487890091
Name:MCCANDLESS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MCCANDLESS CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JONAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANDLESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-914-0349
Mailing Address - Street 1:425 W PINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9692
Mailing Address - Country:US
Mailing Address - Phone:816-322-4774
Mailing Address - Fax:816-322-6670
Practice Address - Street 1:425 W PINE ST STE A
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9692
Practice Address - Country:US
Practice Address - Phone:816-322-4774
Practice Address - Fax:816-322-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006025818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty