1194822619 NPI number — KIRK L. HENRICHS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194822619 NPI number — KIRK L. HENRICHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIRK L. HENRICHS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STOUT-HENRICHS CHIROPRACTIC CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194822619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 AVENUE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DODGE CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-227-7082
Provider Business Mailing Address Fax Number:
620-227-8175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1805 AVENUE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DODGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-227-7082
Provider Business Practice Location Address Fax Number:
620-227-8175
Provider Enumeration Date:
09/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENRICHS
Authorized Official First Name:
KIRK
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
620-227-7082

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  01-04116 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CF8642 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 060062 . This is a "MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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