Custom Chiropractic Center LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

01-04887 Issued in KS

Legal business name

CUSTOM CHIROPRACTIC CENTER LLC

Practice address

6220 Antioch Rd
Suite 200
Shawnee Mission, KS 66202-2866

Phone

(913) 722-1113

Fax

(913) 722-2677

NPI assigned

Aug 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Arvil Lonnie Rudd, D.C.NPI 1396832812

Title

President

Phone

(913) 722-1113

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Arvil Lonnie Rudd, DC

  • Chiropractor
  • Shawnee Mission, KS
  • NPI 1396832812
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1659562148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6220 ANTIOCH RD",
            "address_2": "SUITE 200",
            "city": "SHAWNEE MISSION",
            "state": "KS",
            "postal_code": "662022866",
            "telephone_number": "913-722-1113",
            "fax_number": "913-722-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6220 ANTIOCH RD",
            "address_2": "SUITE 200",
            "city": "SHAWNEE MISSION",
            "state": "KS",
            "postal_code": "662022866",
            "telephone_number": "913-722-1113",
            "fax_number": "913-722-2677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM CHIROPRACTIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-08",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "RUDD",
        "authorized_official_first_name": "ARVIL",
        "authorized_official_middle_name": "LONNIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "913-722-1113",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "KS",
            "license": "01-04887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "33911023",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00220339",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• E Evonne Cooper, PT
• Brad Alan Cosens, RPH
• Elisabeth L Cozad, D.O.
• Lorene Creasser, ARNP
• Sara Elizabeth Cross
• Haley Daeschler
• Sandra Danielsen
• Yvonne Lendy Daugherty, MD
• Angela Davis
• Randall D. Davis, CRNA

• Chiropractor in Shawnee Mission, KS
• Providers in Shawnee Mission, KS by specialty
• Chiropractor in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.