Provider Demographics
NPI:1881703833
Name:CHIROPRACTIC HEALTH CENTER
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:DANE
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DABCI
Authorized Official - Phone:316-321-1771
Mailing Address - Street 1:405 BUSINESS CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-9017
Mailing Address - Country:US
Mailing Address - Phone:316-321-1771
Mailing Address - Fax:316-321-1772
Practice Address - Street 1:405 BUSINESS CIRCLE
Practice Address - Street 2:SUITE B
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3425
Practice Address - Country:US
Practice Address - Phone:316-321-1771
Practice Address - Fax:316-321-1772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104013111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014240Medicare PIN
KST95901Medicare UPIN