Provider Demographics
NPI:1841279437
Name:PICKERING, JOHN G (DC ,BS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:PICKERING
Suffix:
Gender:M
Credentials:DC ,BS
Other - Prefix:
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Mailing Address - Street 1:535 N MUR LEN RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1267
Mailing Address - Country:US
Mailing Address - Phone:913-390-5533
Mailing Address - Fax:913-390-5545
Practice Address - Street 1:535 N MUR LEN RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1267
Practice Address - Country:US
Practice Address - Phone:913-390-5533
Practice Address - Fax:913-390-5545
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS95 876351 01Medicaid
KS95 876351 01Medicaid