Provider Demographics
NPI:1366541179
Name:EASTES, KIM L (DC)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:L
Last Name:EASTES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S MAIZE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-3145
Mailing Address - Country:US
Mailing Address - Phone:316-259-8121
Mailing Address - Fax:
Practice Address - Street 1:215 S MAIZE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-3145
Practice Address - Country:US
Practice Address - Phone:316-259-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS62134OtherBCBS
KS62134OtherBCBS