Provider Demographics
NPI:1356725568
Name:KANSAS SPINE CENTER LLC
Entity type:Organization
Organization Name:KANSAS SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:D
Authorized Official - Last Name:MALLARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-232-9900
Mailing Address - Street 1:1232 NW HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66608-1440
Mailing Address - Country:US
Mailing Address - Phone:785-232-9900
Mailing Address - Fax:
Practice Address - Street 1:1232 NW HARRISON ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66608-1440
Practice Address - Country:US
Practice Address - Phone:785-232-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty