Healthcare Provider Details

I. General information

NPI: 1174635528
Provider Name (Legal Business Name): HAMMOND CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10610 SHAWNEE MISSION PKWY STE 210
SHAWNEE KS
66203-3508
US

IV. Provider business mailing address

10610 SHAWNEE MISSION PKWY STE 210
SHAWNEE KS
66203-3508
US

V. Phone/Fax

Practice location:
  • Phone: 913-248-9500
  • Fax: 913-248-1212
Mailing address:
  • Phone: 913-248-9500
  • Fax: 913-248-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104568
License Number StateKS

VIII. Authorized Official

Name: TRACY ELLIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 913-248-9500