Provider Demographics
NPI:1609811819
Name:TIM BHAKTA, PA
Entity Type:Organization
Organization Name:TIM BHAKTA, PA
Other - Org Name:ACTIVE CHIROPRACTIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-397-6900
Mailing Address - Street 1:PO BOX 2875
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66063-0875
Mailing Address - Country:US
Mailing Address - Phone:913-397-6900
Mailing Address - Fax:913-397-7999
Practice Address - Street 1:401 S CLAIRBORNE RD
Practice Address - Street 2:STE 202
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1735
Practice Address - Country:US
Practice Address - Phone:913-397-6900
Practice Address - Fax:913-397-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS36022028OtherBLUE CROSS BLUE SHIELD KANSAS CITY
KS36022028OtherBLUE CROSS BLUE SHIELD KANSAS CITY