Individual
JACOB THOMAS BROWNBACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4628 LAFAYETTE AVE, KANSAS CITY, KS 66104
(913) 302-9317
Mailing address
4628 LAFAYETTE AVE, KANSAS CITY, KS 66104-3335
(913) 302-9317
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
2012021520
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000010702
NATA BOARD OF CERTIFICATION
—
Enumeration date
09/24/2013
Last updated
09/24/2013
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