Healthcare Provider Details

I. General information

NPI: 1679913974
Provider Name (Legal Business Name): KANSAS TOTAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W 31ST ST S
WICHITA KS
67217-2536
US

IV. Provider business mailing address

4731 W ATLANTIC AVE STE B21
DELRAY BEACH FL
33445-3897
US

V. Phone/Fax

Practice location:
  • Phone: 316-529-3700
  • Fax: 561-495-1214
Mailing address:
  • Phone: 561-495-1212
  • Fax: 561-495-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104242
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0105537
License Number StateKS

VIII. Authorized Official

Name: DR. BRIAN MITTELDORF
Title or Position: OWNER
Credential: D.C.
Phone: 561-495-1212