Provider Demographics
NPI:1609070606
Name:DECOURCY CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:DECOURCY CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:ST JOHN
Authorized Official - Last Name:DECOURCY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-383-3031
Mailing Address - Street 1:10425 MARTY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66061
Mailing Address - Country:US
Mailing Address - Phone:913-383-3031
Mailing Address - Fax:913-383-3041
Practice Address - Street 1:10425 MARTY ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-383-3031
Practice Address - Fax:913-383-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
15338029OtherBLUE CROSS BLUE SHIELD
R470000Medicare ID - Type Unspecified