Provider Demographics
NPI:1285330142
Name:NEWELL, KOLT (DC)
Entity type:Individual
Prefix:
First Name:KOLT
Middle Name:
Last Name:NEWELL
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 1:8616 W 78TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2620
Mailing Address - Country:US
Mailing Address - Phone:785-839-8223
Mailing Address - Fax:
Practice Address - Street 1:8616 W 78TH TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2620
Practice Address - Country:US
Practice Address - Phone:785-839-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023001292111N00000X
KS01-06235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor