Provider Demographics
NPI:1902130834
Name:LOUISBURG CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:LOUISBURG CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:M
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-837-2910
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-0788
Mailing Address - Country:US
Mailing Address - Phone:913-837-2910
Mailing Address - Fax:913-837-2910
Practice Address - Street 1:11 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-3613
Practice Address - Country:US
Practice Address - Phone:913-837-2910
Practice Address - Fax:913-837-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS023737Medicare PIN