Healthcare Provider Details

I. General information

NPI: 1194822619
Provider Name (Legal Business Name): KIRK L. HENRICHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 AVENUE A
DODGE CITY KS
67801
US

IV. Provider business mailing address

1805 AVENUE A
DODGE CITY KS
67801
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: DR. KIRK LYNN HENRICHS
Title or Position: SOLE PROPRIETOR
Credential: D.C.
Phone: 620-227-7082