Provider Demographics
NPI:1841411675
Name:BRAKHAGE, WENDY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:ANN
Last Name:BRAKHAGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:BRILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2300 HUTTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4403
Mailing Address - Country:US
Mailing Address - Phone:913-721-0060
Mailing Address - Fax:913-721-2553
Practice Address - Street 1:2300 HUTTON ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109
Practice Address - Country:US
Practice Address - Phone:913-721-0060
Practice Address - Fax:913-721-2553
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS39598016OtherBCBS GROUP NUMBER
KSDO9726OtherRAILROAD MEDICARE PTAN
KS1063600518OtherRAILROAD MEDICARE NPI
KS27743046OtherBCBS PROVIDER NUMBER
KS12499665OtherMULTIPLAN
KSY19A876OtherMEDICARE PROVIDER NUMBER
KSY190000OtherMEDICARE GROUP NUMBER