Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 01-03761 | KS |
NPI | 1265523179 |
---|---|
Provider Name | Dr. Stephen C Gradwohl |
First Address | Lenexa, KS 66220-9702 |
Second Address | Overland Park, KS 66210-2761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12139018 | BC/BS K.C. (01) | KS |