Provider Demographics
NPI:1487906889
Name:NULL CHIROPRACTIC LLC
Entity type:Organization
Organization Name:NULL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:NULL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-331-1520
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-1090
Mailing Address - Country:US
Mailing Address - Phone:620-331-1520
Mailing Address - Fax:620-331-7199
Practice Address - Street 1:204 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3132
Practice Address - Country:US
Practice Address - Phone:620-331-1520
Practice Address - Fax:620-331-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty