Provider Demographics
NPI:1578957809
Name:LACYGNE CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:LACYGNE CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAINBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-909-8965
Mailing Address - Street 1:116 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LACYGNE
Mailing Address - State:KS
Mailing Address - Zip Code:66040-4197
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 PARK ST
Practice Address - Street 2:
Practice Address - City:LACYGNE
Practice Address - State:KS
Practice Address - Zip Code:66040-4197
Practice Address - Country:US
Practice Address - Phone:913-909-8965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty