Provider Demographics
NPI:1861862856
Name:BOLLENBACH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BOLLENBACH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR/SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-347-5900
Mailing Address - Street 1:940 N TYLER RD
Mailing Address - Street 2:STE 103
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3265
Mailing Address - Country:US
Mailing Address - Phone:316-347-5900
Mailing Address - Fax:316-213-1002
Practice Address - Street 1:940 N TYLER RD
Practice Address - Street 2:STE 103
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3265
Practice Address - Country:US
Practice Address - Phone:316-347-5900
Practice Address - Fax:316-213-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty