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General NPI Number Information
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NPI Number | 1437530490
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Entity Type | Organization
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Legal Business Name | SALT CITY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 1703 LANDON ST SUITE A
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City | HUTCHINSON
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State | KS
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Zip | 67502-5663
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Country | US
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Telephone | 620-860-2174
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Fax |
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Provider Business Mailing Address
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Address Line | 1703 LANDON ST SUITE A
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City | HUTCHINSON
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State | KS
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Zip | 67502-5663
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Country | US
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Telephone | 620-860-2174
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BROCK WELLS
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Credential | DC
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Telephone | 620-860-2174
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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 | 01-05706
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License Number State | KS
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