MEDICARE: WICHITA CHIROPRACTIC CLINIC

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	0105475	KS

General Provider Information

NPI Number	:	1972948149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WICHITA CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	1999 N AMIDON AVE STE 224
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-2123
Country	:	US
Telephone Number	:	316-838-8883
Fax Number	:	316-838-8884

Provider Business Practice Location Address
First Line	:	1999 N AMIDON AVE STE 224
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-2123
Country	:	US
Telephone Number	:	316-838-8883
Fax Number	:	316-838-8884

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. JUAN MARTINEZ JR.
Credential	:	D.C.
Telephone Number	:	316-838-8883

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	05/01/2013

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Directions to “WICHITA CHIROPRACTIC CLINIC ” Practice Location

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