Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 01-04070 | KS |
N | 111NN1001X | Nutrition | 01-04070 | KS |
NPI | 1053340703 |
---|---|
Provider Name | Dr. Jeffrey Hennes |
First Address | Wichita, KS 67218-2900 |
Second Address | Wichita, KS 67218-2900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01-04070 | LICENSE (01) | KS |
U23555 | (02) | KS |