Provider Demographics
NPI:1902959174
Name:CAPITOL CITY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:CAPITOL CITY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-234-0900
Mailing Address - Street 1:1835 NW TOPEKA BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66608-1888
Mailing Address - Country:US
Mailing Address - Phone:785-234-0900
Mailing Address - Fax:785-234-5832
Practice Address - Street 1:1835 NW TOPEKA BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66608-1888
Practice Address - Country:US
Practice Address - Phone:785-234-0900
Practice Address - Fax:785-234-5832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSCH3938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062443OtherBCBS PIN #
KS660188OtherBLUE CROSS AND BLUE SHIELD
KSP00896062OtherMEDICARE PROVIDER PTAN
KS350048346OtherRR MEDICARE PROVIDER #
KSDR2741OtherMEDICARE GROUP PTAN
KS001960184003OtherUNITED HEALTHCARE PROV #
KS0007402220OtherAETNA PROVIDER #
KS660188Medicare PIN
KS660188OtherBLUE CROSS AND BLUE SHIELD
KS060381Medicare ID - Type UnspecifiedMEDICARE PROVIDER #