Healthcare Provider Details

I. General information

NPI: 1710954862
Provider Name (Legal Business Name): FRANK A JIMENEZ II DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13200 W 95TH ST
LENEXA KS
66215-3731
US

IV. Provider business mailing address

13200 W 95TH ST
LENEXA KS
66215-3731
US

V. Phone/Fax

Practice location:
  • Phone: 913-888-2066
  • Fax: 913-888-4851
Mailing address:
  • Phone: 913-888-2066
  • Fax: 913-888-4851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number0104988
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: