=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639259799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOPPS CHIROPRACTIC CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5119 E KELLOGG DR
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-1625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-685-0608
-----------------------------------------------------
Fax | 316-686-3278
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5119 E KELLOGG DR
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-1625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-685-0608
-----------------------------------------------------
Fax | 316-686-3278
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | DR. BRADLEY EUGENE DOPPS
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 316-685-0608
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | C3363
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------