Provider Demographics
NPI:1467558676
Name:CARPENTER, CHASE R (DC)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:R
Last Name:CARPENTER
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:PO BOX 436
Mailing Address - Street 2:714 MAIN
Mailing Address - City:PLEASANTON
Mailing Address - State:KS
Mailing Address - Zip Code:66075-0436
Mailing Address - Country:US
Mailing Address - Phone:913-352-8344
Mailing Address - Fax:913-352-6675
Practice Address - Street 1:714 MAIN
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:KS
Practice Address - Zip Code:66075
Practice Address - Country:US
Practice Address - Phone:913-352-8344
Practice Address - Fax:913-352-6675
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4776111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060922OtherBLUE CROSS BLUE SHIELD
KS060922Medicare ID - Type UnspecifiedMEDICARE
KSU81950Medicare UPIN
KS060922OtherBLUE CROSS BLUE SHIELD