1265614010 NPI number — DECKER CHIROPRACTIC WALK-IN-CARE, PA

Table of content: (NPI 1265614010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265614010 NPI number — DECKER CHIROPRACTIC WALK-IN-CARE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DECKER CHIROPRACTIC WALK-IN-CARE, PA
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:
1265614010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13025 S MUR LEN RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
OLATHE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66062-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-829-5111
Provider Business Mailing Address Fax Number:
913-829-5179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13025 S MUR LEN RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66062-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-829-5111
Provider Business Practice Location Address Fax Number:
913-829-5179
Provider Enumeration Date:
12/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DECKER
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DOCTOR/ OWNER
Authorized Official Telephone Number:
913-829-5111

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  01-04124 , 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: 1740223288 . This is a "NPI GROUP" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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