MEDICARE: SUMMIT CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1316722382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT CHIROPRACTIC

Provider Business Mailing Address
First Line	:	1656 S LOGAN PASS
Second Line	:
City	:	ANDOVER
State	:	KS
Zip	:	67002-7914
Country	:	US
Telephone Number	:	316-313-6680
Fax Number	:

Provider Business Practice Location Address
First Line	:	1819 N GREENWICH RD STE A
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-3103
Country	:	US
Telephone Number	:	316-313-6680
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACOB WILLIAM GAWITH
Credential	:	DC
Telephone Number	:	316-313-6680

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	11/01/2023

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Directions to “SUMMIT CHIROPRACTIC ” Practice Location

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