Individual
DR. JEREMIAH FREDERICK SAMPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C., B.S.
Contact information
Practice address
2548 S DALTON ST, WICHITA, KS 67210-1909
(316) 214-0720
Mailing address
2548 S DALTON ST, WICHITA, KS 67210-1909
(316) 214-0720
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1856
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1856
NEBRASKA CHIROPRACTIC LICENSE NUMBER
—
Enumeration date
08/31/2015
Last updated
08/31/2015
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