Provider Demographics
NPI:1659689180
Name:CHIROPRACTIC GROUP OF OVERLAND PARK LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC GROUP OF OVERLAND PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-383-2276
Mailing Address - Street 1:8764 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-4049
Mailing Address - Country:US
Mailing Address - Phone:913-383-2276
Mailing Address - Fax:913-383-2279
Practice Address - Street 1:8764 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-4049
Practice Address - Country:US
Practice Address - Phone:913-383-2276
Practice Address - Fax:913-383-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-5232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty