Provider Demographics
NPI:1093059057
Name:DRAKE CHIROPRACTIC AND REHAB
Entity Type:Organization
Organization Name:DRAKE CHIROPRACTIC AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-708-0867
Mailing Address - Street 1:22575 TONGANOXIE RD
Mailing Address - Street 2:
Mailing Address - City:TONGANOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:66086-4229
Mailing Address - Country:US
Mailing Address - Phone:913-708-0867
Mailing Address - Fax:
Practice Address - Street 1:1106 N 155TH ST
Practice Address - Street 2:
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-7100
Practice Address - Country:US
Practice Address - Phone:913-708-0867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty