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General NPI Number Information
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NPI Number | 1619087657
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Entity Type | Organization
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Legal Business Name | AUGUSTA CHIROPRACTIC HEALTH CENTER, INC.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 02/01/2018
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Provider Practice Location Address
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Address Line | 514 STATE ST
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City | AUGUSTA
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State | KS
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Zip | 67010-1108
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Country | US
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Telephone | 316-775-0077
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Fax | 316-775-2718
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Provider Business Mailing Address
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Address Line | 1402 OHIO ST
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City | AUGUSTA
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State | KS
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Zip | 67010-1842
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Country | US
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Telephone | 316-775-0077
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Fax | 316-775-2718
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MERVIN DENNIS MCCORMAC
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Credential | D.C.
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Telephone | 316-775-0077
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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 | 01-4006
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License Number State | KS
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