Healthcare Provider Details

I. General information

NPI: 1619087657
Provider Name (Legal Business Name): AUGUSTA CHIROPRACTIC HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 STATE ST
AUGUSTA KS
67010-1108
US

IV. Provider business mailing address

1402 OHIO ST
AUGUSTA KS
67010-1842
US

V. Phone/Fax

Practice location:
  • Phone: 316-775-0077
  • Fax: 316-775-2718
Mailing address:
  • Phone: 316-775-0077
  • Fax: 316-775-2718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-4006
License Number StateKS

VIII. Authorized Official

Name: DR. MERVIN DENNIS MCCORMAC
Title or Position: PRESIDENT
Credential: D.C.
Phone: 316-775-0077