Basic Information
| Provider Information | |||||||||
| NPI: | 1699921551 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JKR LABS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEW LIFE HEARING CENTER, ACME HEARING AID CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10701 W KELLOGG ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672091221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888442497 | ||||||||
| FaxNumber: | 3167225908 | ||||||||
| Practice Location | |||||||||
| Address1: | 8600 WARD PKWY | ||||||||
| Address2: | SUITE 2080 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641142614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164444547 | ||||||||
| FaxNumber: | 8164442892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2008 | ||||||||
| LastUpdateDate: | 08/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | BRADSHAW | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE ADMINSTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8164444547 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JKR LABS, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.