Provider Demographics
NPI:1871726521
Name:KIVISTO CHIROPRACTIC P.A.
Entity type:Organization
Organization Name:KIVISTO CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:KIVISTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-859-0282
Mailing Address - Street 1:10628 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1651
Mailing Address - Country:US
Mailing Address - Phone:913-859-0282
Mailing Address - Fax:913-859-0283
Practice Address - Street 1:10628 W 87TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-1651
Practice Address - Country:US
Practice Address - Phone:913-859-0282
Practice Address - Fax:913-859-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty