Provider Demographics
NPI:1902903917
Name:KOEHN WELLNESS & CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:KOEHN WELLNESS & CHIROPRACTIC, P.A.
Other - Org Name:KOEHN & HARP FAMILY CHIROPRACTIC, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOEHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-227-9902
Mailing Address - Street 1:2601 CENTRAL AVENUE, SUITE 22
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801
Mailing Address - Country:US
Mailing Address - Phone:620-227-9902
Mailing Address - Fax:620-227-9932
Practice Address - Street 1:2601 CENTRAL AVENUE, SUITE 22
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801
Practice Address - Country:US
Practice Address - Phone:620-227-9902
Practice Address - Fax:620-227-9932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04848111N00000X
KS01-04763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660055OtherBCBS ID NUMBER
KS660055OtherBCBS ID NUMBER