Provider Demographics
NPI:1609854264
Name:WILCOX, DONALD ROBERT (DC DABCO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ROBERT
Last Name:WILCOX
Suffix:
Gender:M
Credentials:DC DABCO
Other - Prefix:
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Mailing Address - Street 1:18 S STATE ST
Mailing Address - Street 2:PO BOX 639
Mailing Address - City:NUNDA
Mailing Address - State:NY
Mailing Address - Zip Code:14517-0639
Mailing Address - Country:US
Mailing Address - Phone:585-468-3440
Mailing Address - Fax:585-468-2835
Practice Address - Street 1:18 S STATE ST
Practice Address - Street 2:
Practice Address - City:NUNDA
Practice Address - State:NY
Practice Address - Zip Code:14517-0639
Practice Address - Country:US
Practice Address - Phone:585-468-3440
Practice Address - Fax:585-468-2835
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003252-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P010003252OtherEXCELLUS
11124949OtherCAQH COALTION FOR AFFORDA
16118444601OtherPRISM HEALTH NETWORK
350033887OtherRR MEDICARE
8808985OtherINDEPENDENT HEALTH
4662645OtherAETNA INC
NYDC0032526OtherWORKERS COMPENSATION
11124949OtherCAQH COALTION FOR AFFORDA
350033887OtherRR MEDICARE