Provider Demographics
NPI:1346265246
Name:ADVANCED HEALTH CONCEPTS, P.A.
Entity Type:Organization
Organization Name:ADVANCED HEALTH CONCEPTS, P.A.
Other - Org Name:DRAKE CHIROPRACTIC/KANSAS P.T. & SPINE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAYLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-651-0156
Mailing Address - Street 1:154 S ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-1152
Mailing Address - Country:US
Mailing Address - Phone:316-651-0156
Mailing Address - Fax:316-684-2225
Practice Address - Street 1:154 S ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1152
Practice Address - Country:US
Practice Address - Phone:316-651-0156
Practice Address - Fax:316-684-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110298OtherBCBS OF KS
KS1244000001Medicare NSC
KS110298Medicare PIN