Provider Demographics
NPI:1740223288
Name:DECKER, GEORGE D (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:D
Last Name:DECKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12805 S MUR LEN RD
Mailing Address - Street 2:SUITE C4
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1234
Mailing Address - Country:US
Mailing Address - Phone:913-829-5111
Mailing Address - Fax:913-829-5179
Practice Address - Street 1:12805 S MUR LEN RD
Practice Address - Street 2:SUITE C4
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1234
Practice Address - Country:US
Practice Address - Phone:913-829-5111
Practice Address - Fax:913-829-5179
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSDB7183OtherRAILROAD MEDICARE
KSP396327Medicare ID - Type UnspecifiedPROVIDER MEDICARE
KSU36451Medicare UPIN
KSP390000Medicare ID - Type UnspecifiedGROUP MEDICARE ID