Provider Demographics
NPI:1982726717
Name:FORT SCOTT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FORT SCOTT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:O'DELL
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:620-223-6221
Mailing Address - Street 1:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-1059
Mailing Address - Country:US
Mailing Address - Phone:620-223-6221
Mailing Address - Fax:620-223-3375
Practice Address - Street 1:222 STATE ST
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-2031
Practice Address - Country:US
Practice Address - Phone:620-223-6221
Practice Address - Fax:620-223-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03502261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660166Medicare PIN
KST43867Medicare UPIN