Healthcare Provider Details

I. General information

NPI: 1700254174
Provider Name (Legal Business Name): SAM L HARWOOD PA-C, DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 SW 3RD ST
TOPEKA KS
66606-2442
US

IV. Provider business mailing address

2660 SW 3RD ST
TOPEKA KS
66606-2442
US

V. Phone/Fax

Practice location:
  • Phone: 785-270-8880
  • Fax: 785-270-8881
Mailing address:
  • Phone: 785-270-8880
  • Fax: 785-270-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02952
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-05743
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: