Provider Demographics
NPI:1437146040
Name:WEATHERHEAD, KARL DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:DEAN
Last Name:WEATHERHEAD
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 1:7230 W 13TH ST N
Mailing Address - Street 2:STE 2
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2982
Mailing Address - Country:US
Mailing Address - Phone:316-722-1031
Mailing Address - Fax:316-722-1014
Practice Address - Street 1:7230 W 13TH ST N
Practice Address - Street 2:STE 2
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2982
Practice Address - Country:US
Practice Address - Phone:316-722-1031
Practice Address - Fax:316-722-1014
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC-3908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060489Medicare ID - Type Unspecified
U4727Medicare UPIN