Provider Demographics
NPI:1053473520
Name:SPOONEMORE, JEFFREY D (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:SPOONEMORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 E SANTA FE ST
Mailing Address - Street 2:FULK CHIROPRACTIC, P.A.
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1607
Mailing Address - Country:US
Mailing Address - Phone:913-764-6237
Mailing Address - Fax:913-397-8230
Practice Address - Street 1:2110 E SANTA FE ST
Practice Address - Street 2:FULK CHIROPRACTIC, P.A.
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1607
Practice Address - Country:US
Practice Address - Phone:913-764-6237
Practice Address - Fax:913-397-8230
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U83524Medicare UPIN
G59A886Medicare ID - Type Unspecified