Provider Demographics
NPI:1366700080
Name:SHUBERT CHIROPRACTIC PA
Entity type:Organization
Organization Name:SHUBERT CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:SHUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-636-4444
Mailing Address - Street 1:2456 N WOODLAWN BLVD
Mailing Address - Street 2:STE. 5C
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3968
Mailing Address - Country:US
Mailing Address - Phone:316-636-4444
Mailing Address - Fax:316-634-0930
Practice Address - Street 1:2456 N WOODLAWN BLVD
Practice Address - Street 2:STE. 5C
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3968
Practice Address - Country:US
Practice Address - Phone:316-636-4444
Practice Address - Fax:316-634-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1407955396OtherNATIONAL PROVIDER IDENTIFIER