Provider Demographics
NPI:1194822619
Name:KIRK L. HENRICHS
Entity Type:Organization
Organization Name:KIRK L. HENRICHS
Other - Org Name:STOUT-HENRICHS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HENRICHS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-227-7082
Mailing Address - Street 1:1805 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801
Mailing Address - Country:US
Mailing Address - Phone:620-227-7082
Mailing Address - Fax:620-227-8175
Practice Address - Street 1:1805 AVENUE A
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801
Practice Address - Country:US
Practice Address - Phone:620-227-7082
Practice Address - Fax:620-227-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04116111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCF8642OtherRAILROAD MEDICARE
KS060062OtherMEDICARE
KSU38203Medicare UPIN