Provider Demographics
NPI:1184829400
Name:WILKE, JULIE NYQUIST (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:NYQUIST
Last Name:WILKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 ENGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-1101
Mailing Address - Country:US
Mailing Address - Phone:608-238-1483
Mailing Address - Fax:
Practice Address - Street 1:3240 UNIVERSITY AVE
Practice Address - Street 2:STE 1
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3573
Practice Address - Country:US
Practice Address - Phone:608-238-4998
Practice Address - Fax:608-238-6045
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4303-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor