Provider Demographics
NPI:1114152097
Name:COMMUNITY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:COMMUNITY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-294-5501
Mailing Address - Street 1:1612 INDUSTRIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-5280
Mailing Address - Country:US
Mailing Address - Phone:913-294-5501
Mailing Address - Fax:913-294-5343
Practice Address - Street 1:1612 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-5280
Practice Address - Country:US
Practice Address - Phone:913-294-5501
Practice Address - Fax:913-294-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty