Provider Demographics
NPI:1326134057
Name:KOENEN, JEANE R (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANE
Middle Name:R
Last Name:KOENEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-2419
Mailing Address - Country:US
Mailing Address - Phone:913-367-5371
Mailing Address - Fax:913-367-2973
Practice Address - Street 1:522 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-2419
Practice Address - Country:US
Practice Address - Phone:913-367-5371
Practice Address - Fax:913-367-2973
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03677111N00000X
AR1225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS9552064301Medicaid
23818010OtherBCBS OF KANSAS CITY
KST 43959Medicare UPIN
KS007335Medicare ID - Type Unspecified