Provider Demographics
NPI:1356492763
Name:WILKES, DAVID A (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:WILKES
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 1:3484 CHICAGO DR
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-1428
Mailing Address - Country:US
Mailing Address - Phone:616-662-3933
Mailing Address - Fax:
Practice Address - Street 1:3484 CHICAGO DR
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-1428
Practice Address - Country:US
Practice Address - Phone:616-662-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D10057OtherBCBSM