Provider Demographics
NPI:1063674349
Name:WILCOX CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WILCOX CHIROPRACTIC LLC
Other - Org Name:WILCOX CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:416-568-2225
Mailing Address - Street 1:529 N WESTMINSTER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WAYNESFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45896-9449
Mailing Address - Country:US
Mailing Address - Phone:419-568-2225
Mailing Address - Fax:419-568-2020
Practice Address - Street 1:529 N WESTMINSTER ST
Practice Address - Street 2:SUITE B
Practice Address - City:WAYNESFIELD
Practice Address - State:OH
Practice Address - Zip Code:45896-9449
Practice Address - Country:US
Practice Address - Phone:419-568-2225
Practice Address - Fax:419-568-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1083822902Medicare PIN