Provider Demographics
NPI:1710311998
Name:KEVIN STALLBAUMER, D.C. LLC
Entity Type:Organization
Organization Name:KEVIN STALLBAUMER, D.C. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STALLBAUMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-738-6018
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:913-738-6018
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:913-738-6018
Practice Address - Fax:913-383-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-24
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0009926260OtherAETNA
KSKA2629OtherPTAN
42265037OtherBCBS