Provider Demographics
NPI:1689834988
Name:DEGRADO, LTD
Entity Type:Organization
Organization Name:DEGRADO, LTD
Other - Org Name:R.J. DEGRADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:JERRY
Authorized Official - Last Name:DEGRADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-686-7558
Mailing Address - Street 1:1530 S OLIVER ST
Mailing Address - Street 2:SUITE 171
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3240
Mailing Address - Country:US
Mailing Address - Phone:316-686-7558
Mailing Address - Fax:
Practice Address - Street 1:1530 S OLIVER ST
Practice Address - Street 2:SUITE 171
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3240
Practice Address - Country:US
Practice Address - Phone:316-686-7558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS007388Medicare PIN