Healthcare Provider Details

I. General information

NPI: 1518107473
Provider Name (Legal Business Name): JOINTFIT, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 CLOCK TOWER PL STE 110
MANHATTAN KS
66503-6404
US

IV. Provider business mailing address

2004 CLOCK TOWER PL STE 110
MANHATTAN KS
66503-6404
US

V. Phone/Fax

Practice location:
  • Phone: 785-320-6868
  • Fax: 785-320-6861
Mailing address:
  • Phone: 785-320-6868
  • Fax: 785-320-6861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-05246
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number16-00500
License Number StateKS

VIII. Authorized Official

Name: RICHARD EDWARD FOVEAUX
Title or Position: PRESIDENT
Credential: DC, MS, DACBSP
Phone: 785-320-6868