Healthcare Provider Details

I. General information

NPI: 1235332628
Provider Name (Legal Business Name): OSAGE COUNTY CHIROPRACTIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 MAIN ST BOX 329
CARBONDALE KS
66414
US

IV. Provider business mailing address

119 MAIN BOX 329
CARBONDALE KS
66414
US

V. Phone/Fax

Practice location:
  • Phone: 785-836-7500
  • Fax: 785-836-7500
Mailing address:
  • Phone: 785-836-7500
  • Fax: 785-836-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-04642
License Number StateKS

VIII. Authorized Official

Name: DR. MONTE K KUDER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 785-836-7500