Provider Demographics
NPI:1255488516
Name:HENRY C MARQUARDT DC LLC
Entity Type:Organization
Organization Name:HENRY C MARQUARDT DC LLC
Other - Org Name:INTEGRATIVE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MARQUARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-451-7500
Mailing Address - Street 1:8600 W 110TH ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1809
Mailing Address - Country:US
Mailing Address - Phone:913-451-7500
Mailing Address - Fax:913-451-7501
Practice Address - Street 1:8600 W 110TH ST
Practice Address - Street 2:SUITE 211
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1809
Practice Address - Country:US
Practice Address - Phone:913-451-7500
Practice Address - Fax:913-451-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508802695OtherINDIVIDUAL NPI NUMBER
KS32234012OtherBCBS PIN