Healthcare Provider Details

I. General information

NPI: 1760811822
Provider Name (Legal Business Name): BLUECHIP SPINE & SPORTS SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8336 E 21ST ST N SUITE #300
WICHITA KS
67206-2948
US

IV. Provider business mailing address

8336 E 21ST ST N SUITE #300
WICHITA KS
67206-2948
US

V. Phone/Fax

Practice location:
  • Phone: 316-733-8338
  • Fax: 316-733-8343
Mailing address:
  • Phone: 316-733-8338
  • Fax: 316-733-8343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number01-05122
License Number StateKS

VIII. Authorized Official

Name: MR. CASEY T HUMMEL
Title or Position: OWNER
Credential: D.C.
Phone: 316-733-8338