Provider Demographics
NPI:1003052069
Name:SPINE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SPINE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGUNIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-210-5229
Mailing Address - Street 1:PO BOX 12188
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66282-2188
Mailing Address - Country:US
Mailing Address - Phone:913-735-7093
Mailing Address - Fax:913-735-7093
Practice Address - Street 1:10880 BENSON DR STE 2350
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1599
Practice Address - Country:US
Practice Address - Phone:913-735-7093
Practice Address - Fax:913-735-7093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSV00830Medicare UPIN