Provider Demographics
NPI:1689795056
Name:POMEROY CHIROPRACTIC WELLNESS P.A.
Entity Type:Organization
Organization Name:POMEROY CHIROPRACTIC WELLNESS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:POMEROY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-686-2020
Mailing Address - Street 1:6254 E 37TH ST N STE 110
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2054
Mailing Address - Country:US
Mailing Address - Phone:316-686-2020
Mailing Address - Fax:316-691-9859
Practice Address - Street 1:6254 E 37TH ST N STE 110
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67220-2054
Practice Address - Country:US
Practice Address - Phone:316-686-2020
Practice Address - Fax:316-691-9859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660084OtherMEDICARE GROUP
KS62123OtherBCBS
KS62123OtherBCBS
KS062123Medicare ID - Type Unspecified