Provider Demographics
NPI:1568865418
Name:WILCOX, RONALD HOWARD III (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:HOWARD
Last Name:WILCOX
Suffix:III
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 1:218 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-8954
Mailing Address - Country:US
Mailing Address - Phone:269-795-7145
Mailing Address - Fax:
Practice Address - Street 1:218 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-8954
Practice Address - Country:US
Practice Address - Phone:269-795-7145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL432241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor