Provider Demographics
NPI:1801219068
Name:PREMIER CHIROPRACTIC & WELLNESS, P.A.
Entity type:Organization
Organization Name:PREMIER CHIROPRACTIC & WELLNESS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:DIERKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-320-5300
Mailing Address - Street 1:324C SOUTHWIND PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-3134
Mailing Address - Country:US
Mailing Address - Phone:785-320-5300
Mailing Address - Fax:
Practice Address - Street 1:324C SOUTHWIND PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-3134
Practice Address - Country:US
Practice Address - Phone:785-320-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty