Provider Demographics
NPI:1013950971
Name:FALK, NATHAN RAY
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:RAY
Last Name:FALK
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:NATHAN
Other - Middle Name:RAY
Other - Last Name:FALK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:705 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-1506
Mailing Address - Country:US
Mailing Address - Phone:620-431-3300
Mailing Address - Fax:620-431-3377
Practice Address - Street 1:705 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1506
Practice Address - Country:US
Practice Address - Phone:620-431-3300
Practice Address - Fax:620-431-3377
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU90181Medicare UPIN
KS062073Medicare ID - Type Unspecified