Provider Demographics
NPI:1699796698
Name:KIDWELL CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KIDWELL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-575-0763
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:HORTON
Mailing Address - State:KS
Mailing Address - Zip Code:66439-0106
Mailing Address - Country:US
Mailing Address - Phone:913-575-0763
Mailing Address - Fax:785-264-4702
Practice Address - Street 1:106 W 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:HORTON
Practice Address - State:KS
Practice Address - Zip Code:66439-1666
Practice Address - Country:US
Practice Address - Phone:913-575-0763
Practice Address - Fax:785-264-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062327OtherBCBS OF KS PROVIDER ID
KS660153OtherMEDICARE GROUP ID
KS062327OtherMEDICARE PROVIDER ID
KS660153OtherBSBS OF KS GROUP ID
KSV01597Medicare UPIN