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General NPI Number Information
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NPI Number | 1053792606
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Entity Type | Organization
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Legal Business Name | ETHERTON CHIROPRACTIC LLC
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 917 PINE AVE B
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City | HOXIE
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State | KS
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Zip | 67740
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Country | US
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Telephone | 785-677-3944
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Fax | 785-677-3988
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Provider Business Mailing Address
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Address Line | PO BOX 625
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City | HOXIE
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State | KS
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Zip | 67740-0625
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Country | US
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Telephone | 785-677-3944
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Fax | 785-677-3988
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | RYAN ETHERTON
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Credential | D.C.
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Telephone | 785-677-3944
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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 | 01-05700
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License Number State | KS
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