Provider Demographics
NPI:1932264702
Name:WICKHAM, DAPHNE ANN (DC)
Entity type:Individual
Prefix:DR
First Name:DAPHNE
Middle Name:ANN
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 1:13424 SANTA FE TRAIL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215
Mailing Address - Country:US
Mailing Address - Phone:913-438-1115
Mailing Address - Fax:913-438-3356
Practice Address - Street 1:13424 SANTA FE TRAIL DRIVE
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215
Practice Address - Country:US
Practice Address - Phone:913-438-1115
Practice Address - Fax:913-438-3356
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS31318011OtherBCBS
KS000B359Medicare ID - Type Unspecified