Provider Demographics
NPI:1629461777
Name:GLACIAL HILLS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GLACIAL HILLS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-364-2252
Mailing Address - Street 1:11668 234TH LN
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8390
Mailing Address - Country:US
Mailing Address - Phone:785-364-2252
Mailing Address - Fax:
Practice Address - Street 1:1100 COLUMBINE DR
Practice Address - Street 2:SUITE E
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-8841
Practice Address - Country:US
Practice Address - Phone:785-364-2252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty