Healthcare Provider Details

I. General information

NPI: 1376518811
Provider Name (Legal Business Name): ALPHACARE BACK AND NECK PAIN CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 S SANTA FE AVE
CHANUTE KS
66720-3206
US

IV. Provider business mailing address

2617 S SANTA FE AVE
CHANUTE KS
66720-3206
US

V. Phone/Fax

Practice location:
  • Phone: 620-431-6513
  • Fax: 620-431-6514
Mailing address:
  • Phone: 620-431-6513
  • Fax: 620-431-6514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberKS3651
License Number StateKS

VIII. Authorized Official

Name: DR. SCOTTY BUNCH
Title or Position: PRESIDENT
Credential: D.C.
Phone: 620-431-6513