Provider Demographics
NPI:1104389246
Name:WILD FIRE CHIROPRACTIC
Entity Type:Organization
Organization Name:WILD FIRE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-728-6714
Mailing Address - Street 1:105 S JEFFERSON ST STE B3
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-8833
Mailing Address - Country:US
Mailing Address - Phone:816-281-8300
Mailing Address - Fax:816-281-8300
Practice Address - Street 1:105 S JEFFERSON ST STE B3
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-8833
Practice Address - Country:US
Practice Address - Phone:816-281-8300
Practice Address - Fax:816-281-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty