MEDICARE: GRABOUSKI CHIROPRACTIC AND WELLNESS CENTER LLC

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	261QH0100X	Health Service Clinic/Center	01-05338	KS

General Provider Information

NPI Number	:	1952796633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRABOUSKI CHIROPRACTIC AND WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	9154 W 135TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66221-2044
Country	:	US
Telephone Number	:	913-851-5188
Fax Number	:	855-691-7040

Provider Business Practice Location Address
First Line	:	9154 W 135TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66221-2044
Country	:	US
Telephone Number	:	913-851-5188
Fax Number	:	855-691-7040

Authorized Official
Title or Position	:	OWNER
Name	:	JUSTIN GRABOUSKI
Credential	:	D.C.
Telephone Number	:	913-680-8883

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	10/20/2016

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