Provider Demographics
NPI:1760711667
Name:RUDY C SASINA LLC
Entity Type:Organization
Organization Name:RUDY C SASINA LLC
Other - Org Name:KINGMAN CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SASINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-532-2225
Mailing Address - Street 1:108 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67068-1301
Mailing Address - Country:US
Mailing Address - Phone:620-532-2225
Mailing Address - Fax:620-532-3621
Practice Address - Street 1:108 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1301
Practice Address - Country:US
Practice Address - Phone:620-532-2225
Practice Address - Fax:620-532-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4866261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062043OtherPROVIDER NUMBER
KS062043OtherPROVIDER NUMBER