Provider Demographics
NPI:1740768993
Name:NULL, LOGAN ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:ALAN
Last Name:NULL
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:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-1090
Mailing Address - Country:US
Mailing Address - Phone:620-331-1520
Mailing Address - Fax:
Practice Address - Street 1:204 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3132
Practice Address - Country:US
Practice Address - Phone:620-331-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor