Provider Demographics
NPI:1174635528
Name:HAMMOND CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:HAMMOND CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-248-9500
Mailing Address - Street 1:10610 SHAWNEE MISSION PKWY
Mailing Address - Street 2:STE 210
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-3508
Mailing Address - Country:US
Mailing Address - Phone:913-248-9500
Mailing Address - Fax:913-248-1212
Practice Address - Street 1:10610 SHAWNEE MISSION PKWY
Practice Address - Street 2:STE 210
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-3508
Practice Address - Country:US
Practice Address - Phone:913-248-9500
Practice Address - Fax:913-248-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2040001OtherPTAN
MOMA2040Medicare PIN
MA2040001OtherPTAN
KSU84785Medicare UPIN