Provider Demographics
NPI:1699708594
Name:KP CHIROPRACTIC PC
Entity type:Organization
Organization Name:KP CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:POHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-221-0883
Mailing Address - Street 1:7450 BRIDGEWOOD BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8274
Mailing Address - Country:US
Mailing Address - Phone:515-201-0883
Mailing Address - Fax:
Practice Address - Street 1:720 E THUNDERBIRD RD
Practice Address - Street 2:SUITE #1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5396
Practice Address - Country:US
Practice Address - Phone:602-439-1515
Practice Address - Fax:602-439-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0936060OtherBLUE CROSS BLUE SHIELD
AZZ115505Medicare PIN