MEDICARE: RANDY R. WHEELER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0100X	Occupational Health Chiropractor	01-03800	KS

General Provider Information

NPI Number	:	1407912231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY R. WHEELER D.C.

Provider Business Mailing Address
First Line	:	2368 S MAIN ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67213-4814
Country	:	US
Telephone Number	:	316-264-2208
Fax Number	:	316-264-4146

Provider Business Practice Location Address
First Line	:	5003 E. 61ST ST. NORTH
Second Line	:
City	:	KECHI
State	:	KS
Zip	:	67067
Country	:	US
Telephone Number	:	316-264-2208
Fax Number	:	316-264-4146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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