Provider Demographics
NPI:1093942583
Name:MAXLIFE HEALTH & LASER CENTER, PA
Entity Type:Organization
Organization Name:MAXLIFE HEALTH & LASER CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:UPCHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-327-7246
Mailing Address - Street 1:11010 QUIVIRA RD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1239
Mailing Address - Country:US
Mailing Address - Phone:913-327-7246
Mailing Address - Fax:913-327-7248
Practice Address - Street 1:11010 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1239
Practice Address - Country:US
Practice Address - Phone:913-327-7246
Practice Address - Fax:913-327-7248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-4367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1093931743OtherNPI INDIVIDUAL
KS0005648554OtherAETNA
KS39757011OtherBLUE CROSS BLUE SHIELD
KS1093931743Medicare PIN