MEDICARE: SPURGEON CHIROPRACTIC CLINIC, LLC

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	01-05797	KS

General Provider Information

NPI Number	:	1316478944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPURGEON CHIROPRACTIC CLINIC, LLC

Provider Business Mailing Address
First Line	:	12109 GRANADA ST APT 1123
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66209-4225
Country	:	US
Telephone Number	:	913-353-6655
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 E SANTA FE ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66061-3457
Country	:	US
Telephone Number	:	913-353-6655
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RYAN DANIEL SPURGEON
Credential	:	D.C.
Telephone Number	:	913-260-3197

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	03/24/2017

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