Provider Demographics
NPI:1235332628
Name:OSAGE COUNTY CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:OSAGE COUNTY CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:K
Authorized Official - Last Name:KUDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-836-7500
Mailing Address - Street 1:119 MAIN BOX 329
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:KS
Mailing Address - Zip Code:66414
Mailing Address - Country:US
Mailing Address - Phone:785-836-7500
Mailing Address - Fax:785-836-7500
Practice Address - Street 1:119 MAIN ST BOX 329
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:KS
Practice Address - Zip Code:66414
Practice Address - Country:US
Practice Address - Phone:785-836-7500
Practice Address - Fax:785-836-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660065OtherBCBS
KS660065Medicare ID - Type Unspecified