Provider Demographics
NPI:1144702366
Name:CHIROPRACTIC PAIN CLINIC
Entity type:Organization
Organization Name:CHIROPRACTIC PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HUEBNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-766-0460
Mailing Address - Street 1:16314 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9799
Mailing Address - Country:US
Mailing Address - Phone:913-766-0460
Mailing Address - Fax:
Practice Address - Street 1:16314 W 65TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9799
Practice Address - Country:US
Practice Address - Phone:913-766-0460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05910261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center