Provider Demographics
NPI:1114090115
Name:KIRBY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KIRBY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-522-6702
Mailing Address - Street 1:3040 S SENECA ST
Mailing Address - Street 2:STE 4
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-3246
Mailing Address - Country:US
Mailing Address - Phone:316-522-6702
Mailing Address - Fax:316-522-7790
Practice Address - Street 1:3040 S SENECA ST
Practice Address - Street 2:STE 4
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-3246
Practice Address - Country:US
Practice Address - Phone:316-522-6702
Practice Address - Fax:316-522-7790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS=========OtherFEDERAL TAX ID
KS060420Medicare ID - Type UnspecifiedMEDICARE & BCBS PROVIDER
KSU65456Medicare UPIN