Individual
DR. BENNETT MICAH WYLLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
305 NW ENGLEWOOD CT, SUITE 200, GLADSTONE, MO 64118-4072
(816) 454-5433
(816) 454-8455
Mailing address
305 NW ENGLEWOOD CT, SUITE 200, GLADSTONE, MO 64118-4072
(816) 454-5433
(816) 454-8455
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2013013255
MO
Other
Enumeration date
06/03/2013
Last updated
06/03/2013
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