Provider Demographics
NPI:1821274366
Name:CENTRE FOR HEALTH AND WELLNESS, P.A.
Entity Type:Organization
Organization Name:CENTRE FOR HEALTH AND WELLNESS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:HASKELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-225-9922
Mailing Address - Street 1:701 E COMANCHE LN STE B
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-4500
Mailing Address - Country:US
Mailing Address - Phone:620-225-9922
Mailing Address - Fax:620-225-1948
Practice Address - Street 1:701 E COMANCHE LN STE B
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-4500
Practice Address - Country:US
Practice Address - Phone:620-225-9922
Practice Address - Fax:620-225-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060023OtherBCBS OF KS
KS060023OtherBCBS OF KS