Healthcare Provider Details

I. General information

NPI: 1033358585
Provider Name (Legal Business Name): PRAIRIE VILLAGE CHIROPRACTIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 NALL AVE
PRAIRIE VILLAGE KS
66207-2515
US

IV. Provider business mailing address

9401 NALL AVE
PRAIRIE VILLAGE KS
66207-2515
US

V. Phone/Fax

Practice location:
  • Phone: 913-948-6602
  • Fax: 913-948-6603
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number01-04796
License Number StateKS

VIII. Authorized Official

Name: ANGELA RIBASTE
Title or Position: DC
Credential:
Phone: 913-948-6602