Provider Demographics
NPI:1235252545
Name:MINTON, JAY C (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:C
Last Name:MINTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JAY
Other - Middle Name:C
Other - Last Name:MINTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:11940 W CENTRAL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-5180
Mailing Address - Country:US
Mailing Address - Phone:316-729-4447
Mailing Address - Fax:316-448-0412
Practice Address - Street 1:11940 W CENTRAL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5180
Practice Address - Country:US
Practice Address - Phone:316-729-4447
Practice Address - Fax:316-448-0412
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060821OtherBLUE CROSS BLUE SHIELD
KS060821OtherBLUE CROSS BLUE SHIELD
KS060821Medicare ID - Type Unspecified