Healthcare Provider Details

I. General information

NPI: 1184740540
Provider Name (Legal Business Name): DOUGLAS CHIROPRACTIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 W 6TH AVE
EMPORIA KS
66801-2564
US

IV. Provider business mailing address

1331 W 6TH AVE
EMPORIA KS
66801-2564
US

V. Phone/Fax

Practice location:
  • Phone: 620-343-9232
  • Fax: 620-343-9232
Mailing address:
  • Phone: 620-343-9232
  • Fax: 620-343-9232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number01-04630
License Number StateKS

VIII. Authorized Official

Name: DR. BRYAN E DOUGLAS
Title or Position: OWNER
Credential: D.C.
Phone: 620-343-9232