Organization Active NPI

Ottawa Chiropractic Clinic PA

  • Chiropractor
  • Ottawa, KS
National Provider Identifier
1669550026
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
OTTAWA CHIROPRACTIC CLINIC PA
Practice address
1501 S Main St
Ottawa, KS 66067-3802
Phone
(785) 242-4100
Fax
(785) 242-4121
NPI assigned
Nov 2, 2006
Last updated
Oct 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Authorized official

Name
Debbie D Holstine
Title
Insurance Manager
Phone
(785) 242-4100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary

Addresses

Primary practice location

1501 S Main St
Ottawa, KS 66067-3802

Mailing address

1501 S Main St
Ottawa, KS 66067-3802
Phone (785) 242-4100

Other identifiers 1

IdentifierTypeStateIssuer
014267OtherKSBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050404000603 KS Part B Supplier - Clinic/Group Practice 8628025475 Receives reassigned benefits from 2 practitioners
Practice locations: Ottawa, KS

National Provider Directory

National Provider Directory

Locations

1501 S Main St
Ottawa, KS 66067
Phone (785) 242-4100

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1669550026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 S MAIN ST",
            "city": "OTTAWA",
            "state": "KS",
            "postal_code": "660673802",
            "telephone_number": "785-242-4100",
            "fax_number": "785-242-4121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 S MAIN ST",
            "city": "OTTAWA",
            "state": "KS",
            "postal_code": "660673802",
            "telephone_number": "785-242-4100",
            "fax_number": "785-242-4121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTAWA CHIROPRACTIC CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "HOLSTINE",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "INSURANCE MANAGER",
        "authorized_official_telephone_number": "785-242-4100"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "014267",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ottawa, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; 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.