Provider Demographics
NPI:1083258826
Name:ROOTS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ROOTS CHIROPRACTIC LLC
Other - Org Name:ROOTS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAKOTA
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:HEGI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-364-3128
Mailing Address - Street 1:1033 N ROCK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3662
Mailing Address - Country:US
Mailing Address - Phone:316-364-3128
Mailing Address - Fax:316-364-3166
Practice Address - Street 1:1033 N ROCK RD STE 200
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-3662
Practice Address - Country:US
Practice Address - Phone:316-364-3128
Practice Address - Fax:316-364-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty