Provider Demographics
NPI:1679913974
Name:KANSAS TOTAL CARE, LLC
Entity Type:Organization
Organization Name:KANSAS TOTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTELDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-495-1212
Mailing Address - Street 1:4731 W ATLANTIC AVE STE B21
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3897
Mailing Address - Country:US
Mailing Address - Phone:561-495-1212
Mailing Address - Fax:561-495-1214
Practice Address - Street 1:1415 W 31ST ST S
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-2536
Practice Address - Country:US
Practice Address - Phone:316-529-3700
Practice Address - Fax:561-495-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105537111N00000X
KS0104242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty