MEDICARE: WICHITA KINESIOLOGY GROUP P.A..

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	0105556	KS
2	111N00000X	Chiropractor	C-3525	KS

General Provider Information

NPI Number	:	1063598407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WICHITA KINESIOLOGY GROUP P.A..

Provider Business Mailing Address
First Line	:	5205 E KELLOGG DR
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-1634
Country	:	US
Telephone Number	:	316-684-0550
Fax Number	:	316-684-6596

Provider Business Practice Location Address
First Line	:	5205 E KELLOGG DR
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-1634
Country	:	US
Telephone Number	:	316-684-0550
Fax Number	:	316-684-6596

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. MILTON DOWTY
Credential	:	D.C.
Telephone Number	:	316-684-0550

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	06/24/2013

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