Provider Demographics
NPI:1518016203
Name:WHEELER, KEVIN B (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:B
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 1:314 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-4322
Mailing Address - Country:US
Mailing Address - Phone:940-665-7656
Mailing Address - Fax:940-665-7674
Practice Address - Street 1:314 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4322
Practice Address - Country:US
Practice Address - Phone:940-665-7656
Practice Address - Fax:940-665-7674
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0019226-01Medicaid
TX605453OtherBLUECROSS BLUESHIELD
TXU62504Medicare UPIN
TX605453Medicare ID - Type Unspecified