=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568786895
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHWEST KANSAS CHIROPRACTIC, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2010
-----------------------------------------------------
Last Update Date | 09/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 770 S RANGE AVE STE 4
-----------------------------------------------------
City | COLBY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67701-2967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-460-0332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 770 S RANGE AVE STE 4
-----------------------------------------------------
City | COLBY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67701-2967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-460-0332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. AMANDA ZIMMERMAN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 785-460-0332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0105270
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------