Provider Demographics
NPI:1568735173
Name:GULLEDGE FAMILY WELLNESS P.A.
Entity Type:Organization
Organization Name:GULLEDGE FAMILY WELLNESS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE STROM
Authorized Official - Last Name:GULLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-338-1112
Mailing Address - Street 1:11879 W 112TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2725
Mailing Address - Country:US
Mailing Address - Phone:913-338-1112
Mailing Address - Fax:913-338-2079
Practice Address - Street 1:11879 W 112TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2725
Practice Address - Country:US
Practice Address - Phone:913-338-1112
Practice Address - Fax:913-338-2079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05311111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty