=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356443717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDON GALE TROST D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2006
-----------------------------------------------------
Last Update Date | 03/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1319 E 1ST ST
-----------------------------------------------------
City | MCPHERSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67460-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-504-6344
-----------------------------------------------------
Fax | 866-544-7606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1319 E 1ST ST
-----------------------------------------------------
City | MCPHERSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67460-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-504-6344
-----------------------------------------------------
Fax | 866-544-7606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 01-4626
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 176574
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------