Provider Demographics
NPI:1598877391
Name:DALL, THAD R (DC)
Entity Type:Individual
Prefix:MR
First Name:THAD
Middle Name:R
Last Name:DALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1130 WESTPORT DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2863
Mailing Address - Country:US
Mailing Address - Phone:785-539-9113
Mailing Address - Fax:785-539-9118
Practice Address - Street 1:1130 WESTPORT DR
Practice Address - Street 2:SUITE 5
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2863
Practice Address - Country:US
Practice Address - Phone:785-539-9113
Practice Address - Fax:785-539-9118
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060865Medicare ID - Type Unspecified