Healthcare Provider Details

I. General information

NPI: 1649668435
Provider Name (Legal Business Name): ICT CHIROPRACTIC AND ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7732 E CENTRAL AVE SUITE 108
WICHITA KS
67206-2155
US

IV. Provider business mailing address

130 E OAK ST
LITTLE RIVER KS
67457-9185
US

V. Phone/Fax

Practice location:
  • Phone: 620-680-0809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0105673
License Number StateKS

VIII. Authorized Official

Name: SARA LEAVITT
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 620-680-0809