Provider Demographics
NPI:1326026592
Name:VANOMMEN, KENNETH RAY (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:RAY
Last Name:VANOMMEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 N US HIGHWAY 75
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-8008
Mailing Address - Country:US
Mailing Address - Phone:620-331-4737
Mailing Address - Fax:
Practice Address - Street 1:5680 N US HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-8008
Practice Address - Country:US
Practice Address - Phone:620-331-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005068111N00000X
IA04864111N00000X
KS01-05278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T01341Medicare UPIN
MO000031600Medicare ID - Type Unspecified