# MANUAL THERAPY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437194925
- **Authorized official:** DR. DOUGLAS M. KELLING IV D.O. (PHYSICIAN/MEDICAL DIRECTOR)
- **Authorized official phone:** (816) 350-0515

## Contact information

- **Practice address:** 19401 E US HIGHWAY 40, SUITE 200, INDEPENDENCE, MO 64055-5451
- **Practice address phone:** (816) 350-0515
- **Practice address fax:** (816) 350-0516
- **Mailing address:** 19401 E US HIGHWAY 40, SUITE 200, INDEPENDENCE, MO 64055-5451
- **Mailing address phone:** (816) 350-0515
- **Mailing address fax:** (816) 350-0516

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | NULL | Yes |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/18/2006
- **Last updated:** 04/20/2012