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General NPI Number Information
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NPI Number | 1689061368
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Entity Type | Organization
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Legal Business Name | BELLEVILLE CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 1325 18TH ST
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City | BELLEVILLE
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State | KS
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Zip | 66935-2280
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Country | US
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Telephone | 785-346-4749
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Fax |
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Provider Business Mailing Address
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Address Line | 302 W 4TH ST P. O. BOX 173
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City | PORTIS
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State | KS
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Zip | 67474-9260
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Country | US
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Telephone | 785-346-4749
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. LANDON R WOLTERS
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Credential | D.C.
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Telephone | 785-346-4749
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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 | 01-05680
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License Number State | KS
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