=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518160480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARY MINOR CHIROPRACTIC, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 S WASHINGTON AVE
-----------------------------------------------------
City | IOLA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66749-3252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-365-2524
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221 S WASHINGTON AVE
-----------------------------------------------------
City | IOLA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66749-3252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-365-2524
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CARY DANE MINOR
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 620-365-2524
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 01-5050
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------