Provider Demographics
NPI:1588922348
Name:KREBAUM CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KREBAUM CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KREBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-603-6688
Mailing Address - Street 1:1027 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-4219
Mailing Address - Country:US
Mailing Address - Phone:620-603-6688
Mailing Address - Fax:620-603-6148
Practice Address - Street 1:1027 JACKSON ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4219
Practice Address - Country:US
Practice Address - Phone:620-603-6688
Practice Address - Fax:620-603-6148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty