1699796698 NPI number — KIDWELL CHIROPRACTIC LLC

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 1699796698 NPI number — KIDWELL CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDWELL CHIROPRACTIC LLC
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:
Provider Other Organization Name Type Code:
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:
1699796698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HORTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66439-0106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-575-0763
Provider Business Mailing Address Fax Number:
785-264-4702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 W 8TH ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HORTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66439-1666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-575-0763
Provider Business Practice Location Address Fax Number:
785-264-4702
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIDWELL
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
913-575-0763

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  01-04904 , 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: 062327 . This is a "BCBS OF KS PROVIDER ID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 660153 . This is a "MEDICARE GROUP ID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 062327 . This is a "MEDICARE PROVIDER ID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 660153 . This is a "BSBS OF KS GROUP ID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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