Provider Demographics
NPI:1225318629
Name:DANIEL JOHN WILKE, D.C., P.A.
Entity Type:Organization
Organization Name:DANIEL JOHN WILKE, D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-328-8000
Mailing Address - Street 1:1601 SHERMAN AVE
Mailing Address - Street 2:SUITE 540
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5038
Mailing Address - Country:US
Mailing Address - Phone:847-328-8000
Mailing Address - Fax:847-328-8005
Practice Address - Street 1:1601 SHERMAN AVE
Practice Address - Street 2:SUITE 540
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5038
Practice Address - Country:US
Practice Address - Phone:847-328-8000
Practice Address - Fax:847-328-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008891261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center