Provider Demographics
NPI:1770684771
Name:HALIFA, PA
Entity Type:Organization
Organization Name:HALIFA, PA
Other - Org Name:DOPPS CHIROPRACTIC CLINIC S.W.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:P
Authorized Official - Last Name:DOPPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-945-2525
Mailing Address - Street 1:2243 S MERIDIAN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-1911
Mailing Address - Country:US
Mailing Address - Phone:316-945-2525
Mailing Address - Fax:316-945-5694
Practice Address - Street 1:2243 S MERIDIAN AVE
Practice Address - Street 2:STE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-1911
Practice Address - Country:US
Practice Address - Phone:316-945-2525
Practice Address - Fax:316-945-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS01-03653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660080OtherBLUE CROSS BLUE SHIELD
KS660080OtherBLUE CROSS BLUE SHIELD