Organization
BROOKSIDE HEALTH SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL KELLY MILLER DC (CEO)
(816) 523-4600
Entity
Organization
Contact information
Practice address
7337 BROADWAY ST, KANSAS CITY, MO 64114-1357
(816) 523-4600
(816) 523-4724
Mailing address
7337 BROADWAY ST, KANSAS CITY, MO 64114-1357
(816) 523-4600
(816) 523-4724
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
004675
MO
2083X0100X
Occupational Medicine Physician
Primary
R5D43
MO
225100000X
Physical Therapist
2006023685
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09455022
DR MILLER BCBS#
MO
01
—
1093892119
M. KELLY MILLER, DC NPI#
—
01
—
12455029
DR NICHOLS BCBS#
MO
01
—
12973019
GROUP BCBS NUMBER
MO
01
—
1619088879
RAMON NICHOLS, MD NPI#
—
01
—
4598983
AETNA GROUP NUMBER
MO
05
—
756879607
—
MO
Enumeration date
12/20/2006
Last updated
10/26/2011
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