Provider Demographics
NPI:1619992401
Name:WILDS, RONALD K (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:K
Last Name:WILDS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RONALD
Other - Middle Name:
Other - Last Name:WILDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:627 NW MOCK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2413
Mailing Address - Country:US
Mailing Address - Phone:816-229-9393
Mailing Address - Fax:816-229-2765
Practice Address - Street 1:627 NW MOCK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2413
Practice Address - Country:US
Practice Address - Phone:816-229-9393
Practice Address - Fax:816-229-2765
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0004227Medicare ID - Type Unspecified