Provider Demographics
NPI:1629449962
Name:OMNI HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:OMNI HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEADER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BECKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-921-0979
Mailing Address - Street 1:5600 W 95TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2921
Mailing Address - Country:US
Mailing Address - Phone:620-921-0979
Mailing Address - Fax:
Practice Address - Street 1:5600 W 95TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-2921
Practice Address - Country:US
Practice Address - Phone:620-921-0979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty