Provider Demographics
NPI:1669550026
Name:OTTAWA CHIROPRACTIC CLINIC PA
Entity type:Organization
Organization Name:OTTAWA CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-242-4100
Mailing Address - Street 1:1501 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3802
Mailing Address - Country:US
Mailing Address - Phone:785-242-4100
Mailing Address - Fax:785-242-4121
Practice Address - Street 1:1501 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3802
Practice Address - Country:US
Practice Address - Phone:785-242-4100
Practice Address - Fax:785-242-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014267OtherBLUE CROSS BLUE SHIELD
KS014267Medicare ID - Type Unspecified