Organization
CUSTOM CHIROPRACTIC CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ARVIL LONNIE RUDD D.C. (PRESIDENT)
(913) 722-1113
Entity
Organization
Contact information
Practice address
6220 ANTIOCH RD, SUITE 200, SHAWNEE MISSION, KS 66202-2866
(913) 722-1113
(913) 722-2677
Mailing address
6220 ANTIOCH RD, SUITE 200, SHAWNEE MISSION, KS 66202-2866
(913) 722-1113
(913) 722-2677
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
01-04887
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33911023
BLUE CROSS BLUE SHIELD
—
01
—
P00220339
RAILROAD MEDICARE
KS
Enumeration date
08/08/2007
Last updated
04/20/2008
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