Provider Demographics
NPI:1568523116
Name:WIGGINS, JONATHAN ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ALLEN
Last Name:WIGGINS
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 1:7439 W 161ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66085-8854
Mailing Address - Country:US
Mailing Address - Phone:913-681-9355
Mailing Address - Fax:
Practice Address - Street 1:7439 W 161ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66085-8854
Practice Address - Country:US
Practice Address - Phone:913-681-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSV09170Medicare UPIN