Provider Demographics
NPI:1760811822
Name:BLUECHIP SPINE & SPORTS SPECIALISTS, LLC
Entity Type:Organization
Organization Name:BLUECHIP SPINE & SPORTS SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-733-8338
Mailing Address - Street 1:8336 E 21ST ST N
Mailing Address - Street 2:SUITE #300
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2948
Mailing Address - Country:US
Mailing Address - Phone:316-733-8338
Mailing Address - Fax:316-733-8343
Practice Address - Street 1:8336 E 21ST ST N
Practice Address - Street 2:SUITE #300
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2948
Practice Address - Country:US
Practice Address - Phone:316-733-8338
Practice Address - Fax:316-733-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05122111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty