MEDICARE: DR. TIMIR H BHAKTA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	01-04981	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7575730	OTHER		AETNA
2	11513280	OTHER		CAQH
3	36035021	OTHER	KS	BLUE CROSS BLUE SHIELD KANSAS CITY

General Provider Information

NPI Number	:	1063405058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMIR H BHAKTA D.C.

Provider Business Mailing Address
First Line	:	16228 W 132ND ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-1567
Country	:	US
Telephone Number	:	913-948-9696
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 S CLAIRBORNE RD
Second Line	:	SUITE 202
City	:	OLATHE
State	:	KS
Zip	:	66062-1735
Country	:	US
Telephone Number	:	913-397-6900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	04/29/2021

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