1841411675 NPI number — DR. WENDY ANN BRAKHAGE D.C.

Table of content: DR. WENDY ANN BRAKHAGE D.C. (NPI 1841411675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841411675 NPI number — DR. WENDY ANN BRAKHAGE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAKHAGE
Provider First Name:
WENDY
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRILEY
Provider Other First Name:
WENDY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841411675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 HUTTON RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66109-4403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-721-0060
Provider Business Mailing Address Fax Number:
913-721-2553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 HUTTON ROAD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-721-0060
Provider Business Practice Location Address Fax Number:
913-721-2553
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  01-04742 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39598016 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: DO9726 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1063600518 . This is a "RAILROAD MEDICARE NPI" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 27743046 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 12499665 . This is a "MULTIPLAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: Y19A876 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: Y190000 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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