Provider Demographics
NPI:1346439304
Name:ADVANCED CHIROPRACTIC TECHNIQUES, PA
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC TECHNIQUES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:IRVIN
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-962-1300
Mailing Address - Street 1:6901 SHAWNEE MISSION PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4005
Mailing Address - Country:US
Mailing Address - Phone:913-962-1300
Mailing Address - Fax:913-403-8808
Practice Address - Street 1:6901 SHAWNEE MISSION PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-4005
Practice Address - Country:US
Practice Address - Phone:913-962-1300
Practice Address - Fax:913-403-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC3757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11266026OtherBCBS/KS
MO000025726OtherMEDICARE/MO
KSQ860000OtherMEDICARE/KS
KS11266026OtherBCBS/KS