Provider Demographics
NPI:1245253202
Name:WICKHAM, CHERIE (DC)
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:WICKHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5845 HORTON ST 104
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2653
Mailing Address - Country:US
Mailing Address - Phone:913-339-8432
Mailing Address - Fax:913-624-9194
Practice Address - Street 1:5845 HORTON ST 104
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2653
Practice Address - Country:US
Practice Address - Phone:913-339-8432
Practice Address - Fax:913-624-9194
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU92854Medicare UPIN