Organization
DISSOCIATIVE ASSOCIATES, LLC
Active
Other names
Ketamine Clinic RX
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT FANSLER (OFFICE MANAGER)
(816) 678-5969
Entity
Organization
Contact information
Practice address
817 NE ANDERSON LN, LEES SUMMIT, MO 64064-1244
(816) 381-2050
(816) 503-8271
Mailing address
817 NE ANDERSON LN, LEES SUMMIT, MO 64064-1244
(816) 381-2050
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
12/08/2022
Last updated
12/08/2022
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