Provider Demographics
NPI:1467799809
Name:SOUTHWEST CHIROPRACTIC AND WELLNESS, PA
Entity Type:Organization
Organization Name:SOUTHWEST CHIROPRACTIC AND WELLNESS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIEDL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-355-4116
Mailing Address - Street 1:306 W SANTA FE TRAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKIN
Mailing Address - State:KS
Mailing Address - Zip Code:67860-9454
Mailing Address - Country:US
Mailing Address - Phone:620-355-4116
Mailing Address - Fax:
Practice Address - Street 1:306 W SANTA FE TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:LAKIN
Practice Address - State:KS
Practice Address - Zip Code:67860-9454
Practice Address - Country:US
Practice Address - Phone:620-355-4116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty