Healthcare Provider Details

I. General information

NPI: 1063600229
Provider Name (Legal Business Name): SAXON CHIROPRACTIC WELLNESS CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E KANSAS AVE
ULYSSES KS
67880-2125
US

IV. Provider business mailing address

117 E KANSAS AVE
ULYSSES KS
67880-2125
US

V. Phone/Fax

Practice location:
  • Phone: 620-424-5083
  • Fax:
Mailing address:
  • Phone: 620-424-5083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-05091
License Number StateKS

VIII. Authorized Official

Name: DR. FORREST WAYNE SAXON
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 620-424-5083