Provider Demographics
NPI:1093824740
Name:MINOR, CARY DANE (DC)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:DANE
Last Name:MINOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-3252
Mailing Address - Country:US
Mailing Address - Phone:620-365-2524
Mailing Address - Fax:620-365-2523
Practice Address - Street 1:221 S WASHINGTON
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-3252
Practice Address - Country:US
Practice Address - Phone:620-365-2524
Practice Address - Fax:620-365-2523
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-5050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
693237OtherUNITED HEALTHCARE
KS62301OtherBCBS
KS62301OtherBCBS