Provider Demographics
NPI:1619087657
Name:AUGUSTA CHIROPRACTIC HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:AUGUSTA CHIROPRACTIC HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MERVIN
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:MCCORMAC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-775-0077
Mailing Address - Street 1:1402 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-1842
Mailing Address - Country:US
Mailing Address - Phone:316-775-0077
Mailing Address - Fax:316-775-2718
Practice Address - Street 1:514 STATE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-1108
Practice Address - Country:US
Practice Address - Phone:316-775-0077
Practice Address - Fax:316-775-2718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-4006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1194753632OtherINDIVIDUAL NPI NUMBER
KS660063OtherBCBSKS GROUP NUMBER
KS660063Medicare ID - Type UnspecifiedGROUP NUMBER
KS660063OtherBCBSKS GROUP NUMBER