1275927584 NPI number — DR JILL CHIROPRACTIC AND ACUPUNCTURE PA

Table of content: (NPI 1275927584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275927584 NPI number — DR JILL CHIROPRACTIC AND ACUPUNCTURE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR JILL CHIROPRACTIC AND ACUPUNCTURE 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:
6
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:
1275927584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7000 W 121ST ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LEAWOOD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66209-2008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-499-7053
Provider Business Mailing Address Fax Number:
913-387-4849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 W 121ST ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LEAWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66209-2008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-499-7053
Provider Business Practice Location Address Fax Number:
913-387-4849
Provider Enumeration Date:
03/25/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GULLEDGE
Authorized Official First Name:
JILL
Authorized Official Middle Name:
MARIE STROM
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC, CEO
Authorized Official Telephone Number:
913-499-7053

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0105311 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NP0017X , with the licence number: 0105311 , 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)





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