MEDICARE: TATE A. JANSSEN, D.C., 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	4565	KS

General Provider Information

NPI Number	:	1457550394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TATE A. JANSSEN, D.C., P.A.

Provider Business Mailing Address
First Line	:	3110 MESA WAY
Second Line	:	SUITE B
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4200
Country	:	US
Telephone Number	:	785-830-0044
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 MESA WAY
Second Line	:	SUITE B
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4200
Country	:	US
Telephone Number	:	785-830-0044
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TATE A JANSSEN
Credential	:	D.C.
Telephone Number	:	785-830-0044

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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