Provider Demographics
NPI:1881739670
Name:DWORKIS, BRETT MARTIN (DC, CCSP)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:MARTIN
Last Name:DWORKIS
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 S. ROGERS RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062
Mailing Address - Country:US
Mailing Address - Phone:913-782-5000
Mailing Address - Fax:913-782-5005
Practice Address - Street 1:708 S ROGERS RD
Practice Address - Street 2:SUITE A
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1703
Practice Address - Country:US
Practice Address - Phone:913-782-5000
Practice Address - Fax:913-782-5005
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4631111NS0005X
KS01-04631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS000B324OtherKANSAS MEDICARE P10
KS20-0398766OtherTAX ID
KS26604013OtherBCBS
KS000B324OtherKANSAS MEDICARE P10