Organization
ALLEGIANT HEALTH AND LASER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTIN JADE PROVO DC (OWNER)
(785) 242-9393
Entity
Organization
Contact information
Practice address
112 E 17TH ST, OTTAWA, KS 66067-3800
(785) 242-9393
(913) 538-2289
Mailing address
112 E 17TH ST, OTTAWA, KS 66067-3800
(785) 242-9393
(913) 538-2289
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
01-05533
KS
Other
Enumeration date
06/05/2017
Last updated
07/21/2022
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