Provider Demographics
NPI:1467724682
Name:ADVANCED HEALTHCARE & SPORTS INJURY PA
Entity Type:Organization
Organization Name:ADVANCED HEALTHCARE & SPORTS INJURY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:IODICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-764-2271
Mailing Address - Street 1:20160 W 153RD ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-9131
Mailing Address - Country:US
Mailing Address - Phone:913-764-2271
Mailing Address - Fax:913-764-2276
Practice Address - Street 1:20160 W 153RD ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-9131
Practice Address - Country:US
Practice Address - Phone:913-764-2271
Practice Address - Fax:913-764-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05188111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2530Medicare UPIN