Provider Demographics
NPI:1407945637
Name:WILKE, JOHN W (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:WILKE
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 1:400 EAST ST
Mailing Address - Street 2:STE 101
Mailing Address - City:WILTON
Mailing Address - State:WI
Mailing Address - Zip Code:54670-7735
Mailing Address - Country:US
Mailing Address - Phone:608-463-7754
Mailing Address - Fax:
Practice Address - Street 1:400 EAST ST
Practice Address - Street 2:STE 101
Practice Address - City:WILTON
Practice Address - State:WI
Practice Address - Zip Code:54670-7735
Practice Address - Country:US
Practice Address - Phone:608-435-6290
Practice Address - Fax:608-435-6293
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI01321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38825300Medicaid
WI000035894Medicare ID - Type UnspecifiedMEDICARE ID #
WI91-6166687Medicare UPIN