1598034993 NPI number — STAR CHIROPRACTIC FAMILY CLINIC

Table of content: (NPI 1598034993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598034993 NPI number — STAR CHIROPRACTIC FAMILY CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAR CHIROPRACTIC FAMILY CLINIC
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:
1598034993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11644 W 75TH ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SHAWNEE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66214-1372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-248-9900
Provider Business Mailing Address Fax Number:
913-248-9902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11644 W 75TH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SHAWNEE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66214-1372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-248-9900
Provider Business Practice Location Address Fax Number:
913-248-9902
Provider Enumeration Date:
12/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HUSAIN
Authorized Official First Name:
KOKAB
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
913-689-9342

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  0104722 , 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: 29686014 . This is a "BCBSKC" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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