Provider Demographics
NPI:1518257252
Name:LACKEY & NIELSON CHIROPRACTIC PA
Entity Type:Organization
Organization Name:LACKEY & NIELSON CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-663-5632
Mailing Address - Street 1:30 W SHERMAN
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501
Mailing Address - Country:US
Mailing Address - Phone:620-663-5632
Mailing Address - Fax:620-663-4986
Practice Address - Street 1:30 W SHERMAN ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-5428
Practice Address - Country:US
Practice Address - Phone:620-663-5632
Practice Address - Fax:620-663-4986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU78152Medicare UPIN
KSU60950Medicare UPIN