Provider Demographics
NPI:1164521258
Name:WILCOXON, CHRISTOPHER BARRY (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BARRY
Last Name:WILCOXON
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 1:528 DEBBIE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631
Mailing Address - Country:US
Mailing Address - Phone:740-446-0012
Mailing Address - Fax:
Practice Address - Street 1:228 UPPER RIVER ROAD
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631
Practice Address - Country:US
Practice Address - Phone:740-446-3836
Practice Address - Fax:740-446-3790
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2507013Medicaid
OHU74995Medicare UPIN
OHW10838041Medicare ID - Type Unspecified