Provider Demographics
NPI:1083931679
Name:SOLUTIONS INTEGRATIVE MEDICINE AND DIAGNOSTIC CENTER,INC.
Entity Type:Organization
Organization Name:SOLUTIONS INTEGRATIVE MEDICINE AND DIAGNOSTIC CENTER,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:D
Authorized Official - Last Name:DETWILER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-229-8117
Mailing Address - Street 1:800 MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-2960
Mailing Address - Country:US
Mailing Address - Phone:620-229-8117
Mailing Address - Fax:620-229-8003
Practice Address - Street 1:800 MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2960
Practice Address - Country:US
Practice Address - Phone:620-229-8117
Practice Address - Fax:620-229-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062239Medicare PIN