Provider Demographics
NPI:1598034993
Name:STAR CHIROPRACTIC FAMILY CLINIC
Entity Type:Organization
Organization Name:STAR CHIROPRACTIC FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KOKAB
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-689-9342
Mailing Address - Street 1:11644 W 75TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1372
Mailing Address - Country:US
Mailing Address - Phone:913-248-9900
Mailing Address - Fax:913-248-9902
Practice Address - Street 1:11644 W 75TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66214-1372
Practice Address - Country:US
Practice Address - Phone:913-248-9900
Practice Address - Fax:913-248-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104722261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS29686014OtherBCBSKC
KSU86565Medicare UPIN
KS000B266Medicare UPIN