Provider Demographics
NPI:1124137229
Name:LODER, DARREL KENNETH (DC)
Entity type:Individual
Prefix:DR
First Name:DARREL
Middle Name:KENNETH
Last Name:LODER
Suffix:
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 1:121 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LINDSBORG
Mailing Address - State:KS
Mailing Address - Zip Code:67456-2318
Mailing Address - Country:US
Mailing Address - Phone:785-227-4455
Mailing Address - Fax:785-227-2028
Practice Address - Street 1:121 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LINDSBORG
Practice Address - State:KS
Practice Address - Zip Code:67456-2318
Practice Address - Country:US
Practice Address - Phone:785-227-4455
Practice Address - Fax:785-227-2028
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS60038Medicare ID - Type Unspecified
KSU56737Medicare UPIN