Provider Demographics
NPI:1275646382
Name:WILDCAT CHIROPRACTIC SPORTS & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:WILDCAT CHIROPRACTIC SPORTS & WELLNESS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC CCEP CCSP
Authorized Official - Phone:785-323-1923
Mailing Address - Street 1:503 E. BERTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:KS
Mailing Address - Zip Code:66536
Mailing Address - Country:US
Mailing Address - Phone:785-437-6162
Mailing Address - Fax:785-437-6197
Practice Address - Street 1:503 E. BERTRAND AVE
Practice Address - Street 2:
Practice Address - City:ST MARYS
Practice Address - State:KS
Practice Address - Zip Code:66536
Practice Address - Country:US
Practice Address - Phone:785-437-6162
Practice Address - Fax:785-437-6197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
660144Medicare ID - Type UnspecifiedPROVIDER NUMBER
062308Medicare PIN