Provider Demographics
NPI:1043433055
Name:TEEPLE CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:TEEPLE CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TEEPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-724-1538
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007-0233
Mailing Address - Country:US
Mailing Address - Phone:913-724-1538
Mailing Address - Fax:913-724-3222
Practice Address - Street 1:15604 PINEHURST DR
Practice Address - Street 2:SUITE 3A
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012-8233
Practice Address - Country:US
Practice Address - Phone:913-724-1538
Practice Address - Fax:913-724-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660053OtherBCBS - KS GROUP #
KS31740013OtherBCBS - KC GROUP #
KS660053OtherBCBS - KS GROUP #
KSU80807Medicare UPIN