Provider Demographics
NPI:1386969491
Name:TRD CHIROPRACTIC INC
Entity type:Organization
Organization Name:TRD CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THAD
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:DALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-539-9113
Mailing Address - Street 1:1130 WESTPORT DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2863
Mailing Address - Country:US
Mailing Address - Phone:785-539-9113
Mailing Address - Fax:785-539-9118
Practice Address - Street 1:1130 WESTPORT DR
Practice Address - Street 2:SUITE 5
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2863
Practice Address - Country:US
Practice Address - Phone:785-539-9113
Practice Address - Fax:785-539-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty