Healthcare Provider Details

I. General information

NPI: 1982337705
Provider Name (Legal Business Name): RADIANT FAMILY WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12744 S PFLUMM RD
OLATHE KS
66062-3664
US

IV. Provider business mailing address

17701 N US HIGHWAY 169
SMITHVILLE MO
64089-8609
US

V. Phone/Fax

Practice location:
  • Phone: 913-322-0251
  • Fax: 816-817-4861
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: STACIE A KREADY
Title or Position: OFFICE MANAGE
Credential:
Phone: 913-322-0251