Provider Demographics
NPI:1841862752
Name:RISE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:RISE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN MARIE
Authorized Official - Last Name:GAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-491-2418
Mailing Address - Street 1:136 W B AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67068-1309
Mailing Address - Country:US
Mailing Address - Phone:620-491-2418
Mailing Address - Fax:
Practice Address - Street 1:136 W B AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1309
Practice Address - Country:US
Practice Address - Phone:316-249-3174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty