Provider Demographics
NPI:1053306670
Name:SPINAL STRUCTURAL REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:SPINAL STRUCTURAL REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOTZ
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:785-776-1600
Mailing Address - Street 1:445 E POYNTZ AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5045
Mailing Address - Country:US
Mailing Address - Phone:785-776-1600
Mailing Address - Fax:785-776-1625
Practice Address - Street 1:445 E POYNTZ AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5045
Practice Address - Country:US
Practice Address - Phone:785-776-1600
Practice Address - Fax:785-776-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U22168Medicare UPIN
66077Medicare ID - Type Unspecified