Provider Demographics
NPI:1316722382
Name:SUMMIT CHIROPRACTIC
Entity type:Organization
Organization Name:SUMMIT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GAWITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-313-6680
Mailing Address - Street 1:1656 S LOGAN PASS
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-7914
Mailing Address - Country:US
Mailing Address - Phone:316-313-6680
Mailing Address - Fax:
Practice Address - Street 1:1819 N GREENWICH RD STE A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3103
Practice Address - Country:US
Practice Address - Phone:316-313-6680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty