Provider Demographics
NPI:1407056260
Name:FORD CHIROPRACTIC
Entity Type:Organization
Organization Name:FORD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-845-9646
Mailing Address - Street 1:210 WEST ST
Mailing Address - Street 2:P.O. BOX 97
Mailing Address - City:TONGANOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:66086-8927
Mailing Address - Country:US
Mailing Address - Phone:913-845-9646
Mailing Address - Fax:913-369-9646
Practice Address - Street 1:210 WEST ST
Practice Address - Street 2:
Practice Address - City:TONGANOXIE
Practice Address - State:KS
Practice Address - Zip Code:66086-8927
Practice Address - Country:US
Practice Address - Phone:913-845-9646
Practice Address - Fax:913-369-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014619Medicare PIN