Provider Demographics
NPI:1972368843
Name:WICKHAM CHIROPRACTIC PA
Entity Type:Organization
Organization Name:WICKHAM CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-438-1115
Mailing Address - Street 1:13424 SANTA FE TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3655
Mailing Address - Country:US
Mailing Address - Phone:913-438-1115
Mailing Address - Fax:
Practice Address - Street 1:13424 SANTA FE TRAIL DR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3655
Practice Address - Country:US
Practice Address - Phone:913-438-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty