Provider Demographics
NPI:1376710293
Name:ADVANCED SPORTS AND FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ADVANCED SPORTS AND FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WOODLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-643-1771
Mailing Address - Street 1:12643 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1317
Mailing Address - Country:US
Mailing Address - Phone:913-643-1771
Mailing Address - Fax:913-643-1775
Practice Address - Street 1:12643 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1317
Practice Address - Country:US
Practice Address - Phone:913-643-1771
Practice Address - Fax:913-643-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty