Provider Demographics
NPI:1376626077
Name:EISENHAUER, TERRY A (DC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:A
Last Name:EISENHAUER
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 1:1945 S OHIO ST
Mailing Address - Street 2:SUITE B1
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-6791
Mailing Address - Country:US
Mailing Address - Phone:785-825-1919
Mailing Address - Fax:785-825-7157
Practice Address - Street 1:1945 S OHIO ST
Practice Address - Street 2:SUITE B1
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-6791
Practice Address - Country:US
Practice Address - Phone:785-825-1919
Practice Address - Fax:785-825-7157
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062194OtherBCBS INDIVIDUAL PROVIDER
KS062194OtherBCBS INDIVIDUAL PROVIDER