Provider Demographics
NPI:1669571717
Name:SCHUPBACH, TANYA DENILLE (DC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:DENILLE
Last Name:SCHUPBACH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 KANSAS CITY RD
Mailing Address - Street 2:STE 50 FAMILY CHIROPRACTIC CARE
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061
Mailing Address - Country:US
Mailing Address - Phone:913-764-2525
Mailing Address - Fax:913-764-2525
Practice Address - Street 1:1500 KANSAS CITY RD
Practice Address - Street 2:STE 50 FAMILY CHIROPRACTIC CARE
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-764-2525
Practice Address - Fax:913-764-2525
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC4042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS18207019OtherBCBS
KS584011OtherBCBS HMO
KS18207019OtherBCBS