Individual
KENDALL P DESELMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, DC
Contact information
Practice address
221 E 7TH ST, CAMERON, MO 64429-1722
(816) 632-8407
(816) 632-2943
Mailing address
1600 E EVERGREEN ST, PO BOX 557, CAMERON, MO 64429-2400
(816) 632-2101
(816) 649-3383
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
005457
MO
207Q00000X
Family Medicine Physician
Primary
107636
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
249751009
—
MO
01
—
785D378
MEDICARE PART B
MO
01
—
P00191306
MEDICARE RAILROAD
MO
Enumeration date
12/01/2005
Last updated
12/02/2010
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