Provider Demographics
NPI:1619954559
Name:REPP, MICHAEL WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:REPP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 NIEMAN RD
Mailing Address - Street 2:STE 300
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-2906
Mailing Address - Country:US
Mailing Address - Phone:913-268-0355
Mailing Address - Fax:913-268-0908
Practice Address - Street 1:5900 NIEMAN RD STE 300
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-2906
Practice Address - Country:US
Practice Address - Phone:913-268-0355
Practice Address - Fax:913-268-0908
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS08607010OtherBC BS KANSAS
KS0004530Medicare ID - Type Unspecified