Provider Demographics
NPI:1831607118
Name:WADE, JOHNA LEE (DC)
Entity type:Individual
Prefix:DR
First Name:JOHNA
Middle Name:LEE
Last Name:WADE
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:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:BRANDSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65688-0485
Mailing Address - Country:US
Mailing Address - Phone:417-274-4366
Mailing Address - Fax:
Practice Address - Street 1:240 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2726
Practice Address - Country:US
Practice Address - Phone:417-257-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018000970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor