Provider Demographics
NPI:1003982398
Name:PICKERING CHIROPRACTIC CHARTERED
Entity Type:Organization
Organization Name:PICKERING CHIROPRACTIC CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRATIC
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-390-5533
Mailing Address - Street 1:535 N MUR LEN RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1267
Mailing Address - Country:US
Mailing Address - Phone:913-390-5533
Mailing Address - Fax:913-390-5545
Practice Address - Street 1:535 N MUR LEN RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1267
Practice Address - Country:US
Practice Address - Phone:913-390-5533
Practice Address - Fax:913-390-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS24474-02-1OtherBCBS OF KANSAS CITY
KS9587635101Medicaid
KSM810000Medicare ID - Type Unspecified
KS24474-02-1OtherBCBS OF KANSAS CITY