Provider Demographics
NPI:1568734325
Name:LIAUTAUD, THEODORE RICHARD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:RICHARD
Last Name:LIAUTAUD
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TED
Other - Middle Name:RICHARD
Other - Last Name:LIAUTAUD
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:15545 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1434
Mailing Address - Country:US
Mailing Address - Phone:913-894-4428
Mailing Address - Fax:913-894-4427
Practice Address - Street 1:15545 W 87TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1434
Practice Address - Country:US
Practice Address - Phone:913-894-4428
Practice Address - Fax:913-894-4427
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105458111N00000X
MO2011040193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor