Provider Demographics
NPI:1780875112
Name:TALLGRASS CHIROPRACTIC CENTER, P.A.
Entity type:Organization
Organization Name:TALLGRASS CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:REBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-648-8600
Mailing Address - Street 1:7108 W. 119TH STREET
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213
Mailing Address - Country:US
Mailing Address - Phone:913-648-8600
Mailing Address - Fax:855-894-8145
Practice Address - Street 1:7108 W. 119TH STREET
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213
Practice Address - Country:US
Practice Address - Phone:913-648-8600
Practice Address - Fax:855-894-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04687111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1780875112OtherNPI
KS1780875112OtherNPI
KSU83066Medicare UPIN