Provider Demographics
NPI:1144246505
Name:DEGRADO, JOHN A (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:DEGRADO
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:PO BOX 512
Mailing Address - Street 2:216 MERIDIAN ROAD
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0512
Mailing Address - Country:US
Mailing Address - Phone:316-283-3550
Mailing Address - Fax:316-283-2166
Practice Address - Street 1:216 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-5119
Practice Address - Country:US
Practice Address - Phone:316-283-3550
Practice Address - Fax:316-283-2166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3557111N00000X
CO3114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS005364Medicare ID - Type UnspecifiedINDIVIDUAL ID NUMBER
KST44100Medicare UPIN