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General NPI Number Information
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NPI Number | 1366417172
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Entity Type | Organization
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Legal Business Name | SOUTH GATE CHIROPRACTIC, P.A.
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 1945 S OHIO ST SUITE A
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City | SALINA
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State | KS
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Zip | 67401-6791
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Country | US
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Telephone | 785-825-1919
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Fax | 785-825-7157
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Provider Business Mailing Address
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Address Line | 1945 S OHIO ST SUITE A
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City | SALINA
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State | KS
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Zip | 67401-6791
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Country | US
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Telephone | 785-825-1919
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Fax | 785-825-7157
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Authorized Official
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Title or Position | CEO
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Name | DR. TERRY A EISENHAUER
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Credential | D.C.
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Telephone | 785-825-1919
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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 | 01-03916
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License Number State | KS
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