Provider Demographics
NPI:1265674667
Name:MIDWAY CHIROPRACTIC, L.L.C.
Entity type:Organization
Organization Name:MIDWAY CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOSCHA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-282-6818
Mailing Address - Street 1:717 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SMITH CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:66967-2328
Mailing Address - Country:US
Mailing Address - Phone:785-282-6818
Mailing Address - Fax:785-282-6819
Practice Address - Street 1:717 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SMITH CENTER
Practice Address - State:KS
Practice Address - Zip Code:66967-2328
Practice Address - Country:US
Practice Address - Phone:785-282-6818
Practice Address - Fax:785-282-6819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty