1659565109 NPI number — IVY CHIROPRACTIC CLINIC

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 1659565109 NPI number — IVY CHIROPRACTIC CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IVY CHIROPRACTIC 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:
1659565109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8404 W 13TH ST N
Provider Second Line Business Mailing Address:
#150
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67212-2978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-945-9096
Provider Business Mailing Address Fax Number:
316-722-1120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8404 W 13TH ST N
Provider Second Line Business Practice Location Address:
#150
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67212-2978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-945-9096
Provider Business Practice Location Address Fax Number:
316-722-1120
Provider Enumeration Date:
08/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
HANK
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
316-945-9096

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14185 . This is a "BCBS OF KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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