Provider Demographics
NPI:1164791554
Name:COUNSELMAN & WADE CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:COUNSELMAN & WADE CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COUNSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-234-0521
Mailing Address - Street 1:1408 SW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66612-1819
Mailing Address - Country:US
Mailing Address - Phone:785-234-0521
Mailing Address - Fax:785-234-2405
Practice Address - Street 1:1408 SW TOPEKA BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66612-1819
Practice Address - Country:US
Practice Address - Phone:785-234-0521
Practice Address - Fax:785-234-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103233111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty