Healthcare Provider Details

I. General information

NPI: 1578838868
Provider Name (Legal Business Name): KOERNER CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 9TH ST
ELLIS KS
67637-2206
US

IV. Provider business mailing address

105 W 9TH ST
ELLIS KS
67637-2206
US

V. Phone/Fax

Practice location:
  • Phone: 785-726-3452
  • Fax: 785-726-4007
Mailing address:
  • Phone: 785-726-3452
  • Fax: 785-726-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH JOSEPH KOERNER
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 785-628-2105