Provider Demographics
NPI:1265981385
Name:PRAIRIE SAGE FUNCTIONAL MEDICINE AND KINESIOLOGY LLC
Entity type:Organization
Organization Name:PRAIRIE SAGE FUNCTIONAL MEDICINE AND KINESIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:620-276-8743
Mailing Address - Street 1:519 W MARY ST STE 115
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-2782
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:519 W MARY ST STE 115
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-2782
Practice Address - Country:US
Practice Address - Phone:620-276-8743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty