Provider Demographics
NPI:1093835878
Name:MUTH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MUTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-543-2277
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:BUHLER
Mailing Address - State:KS
Mailing Address - Zip Code:67522-0185
Mailing Address - Country:US
Mailing Address - Phone:620-543-2277
Mailing Address - Fax:620-543-2267
Practice Address - Street 1:110 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:BUHLER
Practice Address - State:KS
Practice Address - Zip Code:67522-9802
Practice Address - Country:US
Practice Address - Phone:620-543-2277
Practice Address - Fax:620-543-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSQ450000Medicare PIN
KSQ45B265Medicare ID - Type Unspecified
U86564Medicare UPIN