Provider Demographics
NPI:1104811728
Name:BOTZ, THOMAS E II (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:BOTZ
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 E POYNTZ AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5045
Mailing Address - Country:US
Mailing Address - Phone:785-776-1600
Mailing Address - Fax:785-776-1625
Practice Address - Street 1:445 E POYNTZ AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5045
Practice Address - Country:US
Practice Address - Phone:785-776-1600
Practice Address - Fax:785-776-1625
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0103890OtherLICENSE NUMBER
0103890OtherLICENSE NUMBER
U22168Medicare UPIN