Provider Demographics
NPI:1346411287
Name:MID AMERICA FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:MID AMERICA FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-727-3600
Mailing Address - Street 1:102 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-1639
Mailing Address - Country:US
Mailing Address - Phone:913-727-3600
Mailing Address - Fax:913-727-3602
Practice Address - Street 1:102 OLIVE ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-1639
Practice Address - Country:US
Practice Address - Phone:913-727-3600
Practice Address - Fax:913-727-3602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062411Medicare PIN