Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 01-06077 | KS |
NPI | 1720693724 |
---|---|
Provider Name | Ryan A Prosser |
First Address | Overland Park, KS 66223-2801 |
Second Address | Overland Park, KS 66223-2801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2020 |
Last Update Date | 16/09/2020 |