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General NPI Number Information
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NPI Number | 1013396209
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Entity Type | Organization
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Legal Business Name | KJG LLC
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Dates
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Enumeration Date | 05/21/2015
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 430 MAIN ST
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City | WELLSVILLE
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State | KS
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Zip | 66092-0726
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Country | US
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Telephone | 785-883-9355
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Fax | 785-883-4030
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Provider Business Mailing Address
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Address Line | 430 MAIN ST PO BOX 726
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City | WELLSVILLE
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State | KS
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Zip | 66092-8878
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Country | US
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Telephone | 785-883-9355
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Fax | 785-883-4030
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KRISTINA JEANNE GIBBONS
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Credential | D.C.
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Telephone | 785-883-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0105260
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License Number State | KS
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