Healthcare Provider Details

I. General information

NPI: 1881739670
Provider Name (Legal Business Name): BRETT MARTIN DWORKIS DC, CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 S ROGERS RD SUITE A
OLATHE KS
66062-1703
US

IV. Provider business mailing address

708 S. ROGERS RD. SUITE A
OLATHE KS
66062
US

V. Phone/Fax

Practice location:
  • Phone: 913-782-5000
  • Fax: 913-782-5005
Mailing address:
  • Phone: 913-782-5000
  • Fax: 913-782-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4631
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-04631
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: