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General NPI Number Information
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NPI Number | 1972368843
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Entity Type | Organization
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Legal Business Name | WICKHAM CHIROPRACTIC PA
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 13424 SANTA FE TRAIL DR
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City | LENEXA
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State | KS
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Zip | 66215-3655
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Country | US
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Telephone | 913-438-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 13424 SANTA FE TRAIL DR
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City | LENEXA
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State | KS
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Zip | 66215-3655
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Country | US
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Telephone | 913-438-1115
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Fax |
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Authorized Official
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Title or Position | OWNER/EMPLOYEE
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Name | DR. DAPHNE WICKHAM
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Credential | DC
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Telephone | 913-438-1115
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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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