Provider Demographics
NPI:1831200393
Name:NORTHROCK CHIROPRACTIC CLINIC INC.
Entity type:Organization
Organization Name:NORTHROCK CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:ZWIENER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-636-2226
Mailing Address - Street 1:3500 N. ROCK ROAD
Mailing Address - Street 2:BLDG. 1200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1334
Mailing Address - Country:US
Mailing Address - Phone:316-636-2226
Mailing Address - Fax:316-636-2333
Practice Address - Street 1:3500 N. ROCK ROAD
Practice Address - Street 2:BLDG. 1200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1334
Practice Address - Country:US
Practice Address - Phone:316-636-2226
Practice Address - Fax:316-636-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060050Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER