Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 01-04116 | KS |
NPI | 1013981802 |
---|---|
Provider Name | Dr. Kirk L Henrichs |
First Address | Dodge City, KS 67801-6401 |
Second Address | Dodge City, KS 67801-6401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060062 | BLUE CROSS BLUE SHIELD KS (01) | KS |
U38203 | (02) | KS |