Provider Demographics
NPI:1851621304
Name:PITTSBURG CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:PITTSBURG CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-232-6555
Mailing Address - Street 1:302 E. 4TH ST.
Mailing Address - Street 2:STE. E
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762
Mailing Address - Country:US
Mailing Address - Phone:620-232-6555
Mailing Address - Fax:620-232-6699
Practice Address - Street 1:302 E 4TH ST
Practice Address - Street 2:STE. E
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-4818
Practice Address - Country:US
Practice Address - Phone:620-232-6555
Practice Address - Fax:620-232-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1669Medicare UPIN