Provider Demographics
NPI:1346609468
Name:WILDCAT CHIROPRACTIC PLC
Entity Type:Organization
Organization Name:WILDCAT CHIROPRACTIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:THRAP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-989-4335
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:IA
Mailing Address - Zip Code:50047-0484
Mailing Address - Country:US
Mailing Address - Phone:515-989-4335
Mailing Address - Fax:
Practice Address - Street 1:125 N 1ST ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-7810
Practice Address - Country:US
Practice Address - Phone:515-989-4335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076068305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service