Provider Demographics
NPI:1073673489
Name:PANZER, KODI NICHOLE (DC)
Entity Type:Individual
Prefix:MS
First Name:KODI
Middle Name:NICHOLE
Last Name:PANZER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:KODI
Other - Middle Name:NICHOLE
Other - Last Name:CHARBONNEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:122 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:KS
Mailing Address - Zip Code:67063-1526
Mailing Address - Country:US
Mailing Address - Phone:620-947-3157
Mailing Address - Fax:620-947-2630
Practice Address - Street 1:122 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:KS
Practice Address - Zip Code:67063-1526
Practice Address - Country:US
Practice Address - Phone:620-947-3157
Practice Address - Fax:620-947-2630
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSV11141Medicare UPIN
KS062352Medicare PIN