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General NPI Number Information
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NPI Number | 1114090115
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Entity Type | Organization
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Legal Business Name | KIRBY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3040 S SENECA ST STE 4
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City | WICHITA
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State | KS
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Zip | 67217-3246
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Country | US
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Telephone | 316-522-6702
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Fax | 316-522-7790
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Provider Business Mailing Address
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Address Line | 3040 S SENECA ST STE 4
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City | WICHITA
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State | KS
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Zip | 67217-3246
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Country | US
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Telephone | 316-522-6702
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Fax | 316-522-7790
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | DR. KENNETH A KIRBY
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Credential | D.C.
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Telephone | 316-522-6702
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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 | 0104408
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License Number State | KS
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