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General NPI Number Information
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NPI Number | 1417920653
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Entity Type | Organization
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Legal Business Name | KANSAS JOINT & SPINE INSTITUTE
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 11/14/2012
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Provider Practice Location Address
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Address Line | 10100 SHANNON WOODS
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City | WICHITA
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State | KS
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Zip | 67226
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Country | US
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Telephone | 316-858-1900
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Fax | 316-858-1905
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Provider Business Mailing Address
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Address Line | 10100 SHANNON WOODS
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City | WICHITA
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State | KS
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Zip | 67226
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Country | US
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Telephone | 316-858-1900
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Fax | 316-858-1905
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Authorized Official
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Title or Position | CEO
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Name | DEBBIE BROCK-BAKER
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Credential |
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Telephone | 316-771-4009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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