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General NPI Number Information
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NPI Number | 1104389246
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Entity Type | Organization
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Legal Business Name | WILD FIRE CHIROPRACTIC
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Dates
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Enumeration Date | 04/06/2019
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Last Update Date | 04/06/2019
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Provider Practice Location Address
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Address Line | 105 S JEFFERSON ST STE B3
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City | KEARNEY
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State | MO
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Zip | 64060-8833
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Country | US
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Telephone | 816-281-8300
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Fax | 816-281-8300
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Provider Business Mailing Address
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Address Line | 105 S JEFFERSON ST STE B3
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City | KEARNEY
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State | MO
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Zip | 64060-8833
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Country | US
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Telephone | 816-281-8300
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Fax | 816-281-8300
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. SAMANTHA JO STOKES
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Credential | DC
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Telephone | 816-728-6714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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