=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497478903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL SPINE CHIROPRACTIC AND WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2022
-----------------------------------------------------
Last Update Date | 03/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5931 NIEMAN RD
-----------------------------------------------------
City | SHAWNEE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66203-2931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-617-7348
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5931 NIEMAN RD STE 100
-----------------------------------------------------
City | SHAWNEE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66203-2904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-914-7090
-----------------------------------------------------
Fax | 913-391-6565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALISSA RACHELLE GOULD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 316-617-7348
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------