Provider Demographics
NPI:1083010599
Name:WESTERN KANSAS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WESTERN KANSAS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRONSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-376-8652
Mailing Address - Street 1:920 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871-1819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871-1819
Practice Address - Country:US
Practice Address - Phone:620-872-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty