Provider Demographics
NPI:1760673156
Name:WYANDOTTE FAMILY CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:WYANDOTTE FAMILY CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-334-8080
Mailing Address - Street 1:8135 PARALLEL PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-2010
Mailing Address - Country:US
Mailing Address - Phone:913-334-8080
Mailing Address - Fax:913-334-8081
Practice Address - Street 1:8135 PARALLEL PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2010
Practice Address - Country:US
Practice Address - Phone:913-334-8080
Practice Address - Fax:913-334-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU75401Medicare UPIN