Provider Demographics
NPI:1588726707
Name:LIPERUOTE, ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:LIPERUOTE
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 1:17411 W 163RD ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062
Mailing Address - Country:US
Mailing Address - Phone:816-935-1046
Mailing Address - Fax:
Practice Address - Street 1:2110 E SANTA FE ST
Practice Address - Street 2:FULK CHIROPRACTIC, PA
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1607
Practice Address - Country:US
Practice Address - Phone:913-764-6237
Practice Address - Fax:913-397-8230
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
G59A902Medicare ID - Type Unspecified
U83673Medicare UPIN