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General NPI Number Information
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NPI Number | 1487906889
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Entity Type | Organization
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Legal Business Name | NULL CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 204 E CHESTNUT ST
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City | INDEPENDENCE
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State | KS
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Zip | 67301-3132
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Country | US
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Telephone | 620-331-1520
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Fax | 620-331-7199
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Provider Business Mailing Address
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Address Line | PO BOX 1090
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City | INDEPENDENCE
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State | KS
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Zip | 67301-1090
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Country | US
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Telephone | 620-331-1520
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Fax | 620-331-7199
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Authorized Official
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Title or Position | SOLE MBR
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Name | DR. SCOTT A NULL
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Credential | DC
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Telephone | 620-331-1520
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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 | 01-03564
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License Number State | KS
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