Healthcare Provider Details

I. General information

NPI: 1245500875
Provider Name (Legal Business Name): CARPENTER CHIROPRACTIC HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 MAIN ST
PLEASANTON KS
66075-8262
US

IV. Provider business mailing address

PO BOX 436
PLEASANTON KS
66075-0436
US

V. Phone/Fax

Practice location:
  • Phone: 913-352-8344
  • Fax: 913-352-6675
Mailing address:
  • Phone: 913-352-8344
  • Fax: 913-352-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4776
License Number StateKS

VIII. Authorized Official

Name: CHASE R CARPENTER
Title or Position: SOLE MEMBER
Credential: DC
Phone: 913-352-8344