Provider Demographics
NPI:1780021683
Name:STUPKA CHIROPRACTIC & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:STUPKA CHIROPRACTIC & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STUPKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-504-6677
Mailing Address - Street 1:114 W EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-4206
Mailing Address - Country:US
Mailing Address - Phone:620-504-6677
Mailing Address - Fax:
Practice Address - Street 1:114 W EUCLID ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-4206
Practice Address - Country:US
Practice Address - Phone:620-504-6677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty