Healthcare Provider Details

I. General information

NPI: 1013981802
Provider Name (Legal Business Name): KIRK L HENRICHS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 AVENUE A
DODGE CITY KS
67801-6401
US

IV. Provider business mailing address

1805 AVENUE A
DODGE CITY KS
67801-6401
US

V. Phone/Fax

Practice location:
  • Phone: 620-227-7082
  • Fax: 620-227-8175
Mailing address:
  • Phone: 620-227-7082
  • Fax: 620-227-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number01-04116
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: