Healthcare Provider Details

I. General information

NPI: 1790122869
Provider Name (Legal Business Name): JILL LOREE SIGLE-GEORG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 53
LA CROSSE KS
67548-0053
US

IV. Provider business mailing address

1105 MAIN ST # 53
LA CROSSE KS
67548-8404
US

V. Phone/Fax

Practice location:
  • Phone: 785-222-6088
  • Fax: 785-514-5353
Mailing address:
  • Phone: 785-222-2323
  • Fax: 785-514-5353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-05546
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: