MEDICARE: LACKEY & NIELSON CHIROPRACTIC PA

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	01-04521	KS

General Provider Information

NPI Number	:	1518257252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LACKEY & NIELSON CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	30 W SHERMAN
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67501
Country	:	US
Telephone Number	:	620-663-5632
Fax Number	:	620-663-4986

Provider Business Practice Location Address
First Line	:	30 W SHERMAN ST
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67501-5428
Country	:	US
Telephone Number	:	620-663-5632
Fax Number	:	620-663-4986

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIMOTHY SCOTT LACKEY
Credential	:	D.C.
Telephone Number	:	620-663-5632

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	11/04/2011

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