Provider Demographics
NPI:1972687648
Name:JOHN A DEGRADO, D.C.
Entity type:Organization
Organization Name:JOHN A DEGRADO, D.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEGRADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-283-3550
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:216 MERIDIAN RD STE D
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0512
Mailing Address - Country:US
Mailing Address - Phone:316-283-3550
Mailing Address - Fax:316-283-2166
Practice Address - Street 1:216 N MERIDIAN RD
Practice Address - Street 2:STE D
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-5119
Practice Address - Country:US
Practice Address - Phone:316-283-3550
Practice Address - Fax:316-283-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS=========OtherEMPLOYEE TAX ID
KS023523Medicare ID - Type UnspecifiedPROVIDER ID
KS=========OtherEMPLOYEE TAX ID