Provider Demographics
NPI:1316478944
Name:SPURGEON CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:SPURGEON CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SPURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-260-3197
Mailing Address - Street 1:12109 GRANADA ST APT 1123
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-4225
Mailing Address - Country:US
Mailing Address - Phone:913-353-6655
Mailing Address - Fax:
Practice Address - Street 1:450 E SANTA FE ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3457
Practice Address - Country:US
Practice Address - Phone:913-353-6655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty