Provider Demographics
NPI:1740630029
Name:ABILENE CHIROPRACTIC & SPORTS REHAB LLC
Entity type:Organization
Organization Name:ABILENE CHIROPRACTIC & SPORTS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-571-5090
Mailing Address - Street 1:208 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-2647
Mailing Address - Country:US
Mailing Address - Phone:785-571-5090
Mailing Address - Fax:
Practice Address - Street 1:208 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-2647
Practice Address - Country:US
Practice Address - Phone:785-571-5090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSMA3598004OtherCURRENTLY ENROLLING FOR KANSAS PTAN (LISTED MISSOURI PTAN)