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General NPI Number Information
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NPI Number | 1144702366
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC PAIN CLINIC
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 16314 W 65TH ST
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City | SHAWNEE
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State | KS
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Zip | 66217-9799
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Country | US
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Telephone | 913-766-0460
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Fax |
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Provider Business Mailing Address
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Address Line | 16314 W 65TH ST
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City | SHAWNEE
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State | KS
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Zip | 66217-9799
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Country | US
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Telephone | 913-766-0460
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANA JAMES HUEBNER
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Credential | DC
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Telephone | 913-766-0460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 01-05910
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License Number State | KS
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