Provider Demographics
NPI:1760649610
Name:MIDWEST CHIROPRACTIC CENTER, PA
Entity Type:Organization
Organization Name:MIDWEST CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-369-0022
Mailing Address - Street 1:1198 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TONGANOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:66086-9707
Mailing Address - Country:US
Mailing Address - Phone:913-369-0022
Mailing Address - Fax:913-369-2836
Practice Address - Street 1:1198 FRONT ST
Practice Address - Street 2:
Practice Address - City:TONGANOXIE
Practice Address - State:KS
Practice Address - Zip Code:66086-9707
Practice Address - Country:US
Practice Address - Phone:913-369-0022
Practice Address - Fax:913-369-2836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS104654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU79992Medicare UPIN
KS603781Medicare PIN