Provider Demographics
NPI:1447318100
Name:MUTH, ROSS M (DC)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:M
Last Name:MUTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:BUHLER
Mailing Address - State:KS
Mailing Address - Zip Code:67522-0185
Mailing Address - Country:US
Mailing Address - Phone:620-543-2128
Mailing Address - Fax:
Practice Address - Street 1:110 N MAIN ST.
Practice Address - Street 2:
Practice Address - City:BUHLER
Practice Address - State:KS
Practice Address - Zip Code:67522-9802
Practice Address - Country:US
Practice Address - Phone:620-543-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30008011OtherBLUE CROSS BLUE SHIELD
KSQ45B265Medicare ID - Type Unspecified
KS30008011OtherBLUE CROSS BLUE SHIELD