Provider Demographics
NPI:1548425713
Name:BIO-KINETIC CHIROPRACTIC
Entity Type:Organization
Organization Name:BIO-KINETIC CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILKIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-359-0999
Mailing Address - Street 1:17701 E 39TH ST S STE 100
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-3877
Mailing Address - Country:US
Mailing Address - Phone:816-350-0999
Mailing Address - Fax:
Practice Address - Street 1:17701 E 39TH ST S STE 100
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3877
Practice Address - Country:US
Practice Address - Phone:816-350-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0007062Medicare UPIN