Provider Demographics
NPI:1639280167
Name:GANNAWAY-ZWIENER, KASSIE RENAE (DC)
Entity Type:Individual
Prefix:
First Name:KASSIE
Middle Name:RENAE
Last Name:GANNAWAY-ZWIENER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 N. ROCK ROAD
Mailing Address - Street 2:BLDG. 1200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1334
Mailing Address - Country:US
Mailing Address - Phone:316-636-2226
Mailing Address - Fax:316-636-2333
Practice Address - Street 1:3500 N. ROCK ROAD
Practice Address - Street 2:BLDG. 1200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1334
Practice Address - Country:US
Practice Address - Phone:316-636-2226
Practice Address - Fax:316-636-2333
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU63896Medicare UPIN
KS059939Medicare ID - Type Unspecified