MEDICARE: PROF. TATE ARNETT JANSSEN D.C.

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	4565	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	062197	OTHER	KS	BC/BS PROVIDER NUMBER
2	660112	OTHER	KS	BC/BS GROUP NUMBER

General Provider Information

NPI Number	:	1427133321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. TATE ARNETT JANSSEN D.C.

Provider Business Mailing Address
First Line	:	3110 MESA WAY
Second Line	:	SUITE B
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4200
Country	:	US
Telephone Number	:	785-830-0044
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 MESA WAY
Second Line	:	SUITE B
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4200
Country	:	US
Telephone Number	:	785-830-0044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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