Provider Demographics
NPI:1295387587
Name:KIZZIRE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:KIZZIRE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:MICHAEL JAMES
Authorized Official - Last Name:KIZZIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-672-7608
Mailing Address - Street 1:221 BOX BUTTE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3741
Mailing Address - Country:US
Mailing Address - Phone:308-761-1145
Mailing Address - Fax:
Practice Address - Street 1:221 BOX BUTTE AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3741
Practice Address - Country:US
Practice Address - Phone:308-671-1145
Practice Address - Fax:308-761-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty