Provider Demographics
NPI:1427133321
Name:JANSSEN, TATE ARNETT (DC)
Entity type:Individual
Prefix:PROF
First Name:TATE
Middle Name:ARNETT
Last Name:JANSSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 MESA WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4200
Mailing Address - Country:US
Mailing Address - Phone:785-830-0044
Mailing Address - Fax:
Practice Address - Street 1:3110 MESA WAY
Practice Address - Street 2:SUITE B
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4200
Practice Address - Country:US
Practice Address - Phone:785-830-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062197OtherBC/BS PROVIDER NUMBER
KS660112OtherBC/BS GROUP NUMBER
KS062197Medicare ID - Type UnspecifiedPHYSICIAN PROVIDER NUMBER
KS660112OtherBC/BS GROUP NUMBER