Provider Demographics
NPI:1407912231
Name:WHEELER, RANDY R (DC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:R
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-4814
Mailing Address - Country:US
Mailing Address - Phone:316-264-2208
Mailing Address - Fax:316-264-4146
Practice Address - Street 1:5003 E. 61ST ST. NORTH
Practice Address - Street 2:
Practice Address - City:KECHI
Practice Address - State:KS
Practice Address - Zip Code:67067
Practice Address - Country:US
Practice Address - Phone:316-264-2208
Practice Address - Fax:316-264-4146
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03800111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health