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General NPI Number Information
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NPI Number | 1598034993
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Entity Type | Organization
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Legal Business Name | STAR CHIROPRACTIC FAMILY CLINIC
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 11644 W 75TH ST SUITE 102
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City | SHAWNEE
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State | KS
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Zip | 66214-1372
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Country | US
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Telephone | 913-248-9900
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Fax | 913-248-9902
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Provider Business Mailing Address
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Address Line | 11644 W 75TH ST SUITE 102
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City | SHAWNEE
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State | KS
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Zip | 66214-1372
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Country | US
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Telephone | 913-248-9900
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Fax | 913-248-9902
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Authorized Official
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Title or Position | OWNER
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Name | DR. KOKAB HUSAIN
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Credential | D.C.
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Telephone | 913-689-9342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0104722
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License Number State | KS
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