Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 04-25090 | KS |
Y | 207T00000X | Neurosurgeon | R7H64 | MO |
NPI | 1073585337 |
---|---|
Provider Name | Dr. Jonathan D Chilton |
First Address | Kansas City, MO 64132-1132 |
Second Address | Kansas City, MO 64132-1132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100141030A | (05) | KS |
202582508 | (05) | MO |