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General NPI Number Information
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NPI Number | 1649668435
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Entity Type | Organization
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Legal Business Name | ICT CHIROPRACTIC AND ACUPUNCTURE
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Dates
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Enumeration Date | 12/31/2014
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Last Update Date | 12/31/2014
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Provider Practice Location Address
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Address Line | 7732 E CENTRAL AVE SUITE 108
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City | WICHITA
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State | KS
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Zip | 67206-2155
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Country | US
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Telephone | 620-680-0809
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Fax |
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Provider Business Mailing Address
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Address Line | 130 E OAK ST
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City | LITTLE RIVER
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State | KS
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Zip | 67457-9185
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | SARA LEAVITT
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Credential | D.C.
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Telephone | 620-680-0809
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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 | 0105673
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License Number State | KS
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