Provider Demographics
NPI:1740465301
Name:GIRTH, JENNIFER MARIE (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:GIRTH
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 1:302 E 4TH ST
Mailing Address - Street 2:STE. E
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-4818
Mailing Address - Country:US
Mailing Address - Phone:620-232-6555
Mailing Address - Fax:620-232-6699
Practice Address - Street 1:302 E 4TH ST
Practice Address - Street 2:STE. E
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-4818
Practice Address - Country:US
Practice Address - Phone:620-232-6555
Practice Address - Fax:620-232-6699
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1669Medicare UPIN