Provider Demographics
NPI:1083952915
Name:RONALD WILCOX, DC INC.
Entity Type:Organization
Organization Name:RONALD WILCOX, DC INC.
Other - Org Name:FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-352-8112
Mailing Address - Street 1:204 PINEHURST DR SW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4500
Mailing Address - Country:US
Mailing Address - Phone:360-352-8112
Mailing Address - Fax:360-352-8113
Practice Address - Street 1:204 PINEHURST DR SW
Practice Address - Street 2:SUITE 103
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4500
Practice Address - Country:US
Practice Address - Phone:360-352-8112
Practice Address - Fax:360-352-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001002046OtherMEDICARE
WAG001002046OtherMEDICARE