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General NPI Number Information
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NPI Number | 1639252703
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Entity Type | Organization
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Legal Business Name | ANDOVER CHIROPRACTIC CENTER, INC.
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 320 W CENTRAL AVE SUITE D
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City | ANDOVER
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State | KS
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Zip | 67002-9616
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Country | US
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Telephone | 316-733-5454
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Fax | 316-733-5404
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Provider Business Mailing Address
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Address Line | PO BOX 593
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City | ANDOVER
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State | KS
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Zip | 67002-0593
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Country | US
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Telephone | 316-733-5454
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Fax | 316-733-5404
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. RODNEY PAUL POE
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Credential | D.C.
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Telephone | 316-733-5454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 01-03532
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License Number State | KS
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