Provider Demographics
NPI:1023192325
Name:WILBER, THOMAS ARTHUR (DC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ARTHUR
Last Name:WILBER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30332 HIGHWAY 441 S
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-6348
Mailing Address - Country:US
Mailing Address - Phone:706-335-2225
Mailing Address - Fax:706-335-2231
Practice Address - Street 1:30332 HIGHWAY 441 S
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529
Practice Address - Country:US
Practice Address - Phone:706-335-2225
Practice Address - Fax:706-335-2231
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO05953111N00000X
SC2167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA311771494OtherTAX ID
GAGRP4582 GROUP#35CGWKMedicare ID - Type Unspecified