Provider Demographics
NPI:1619320504
Name:WILKE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WILKE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-457-2224
Mailing Address - Street 1:45 HILLDALE DR STE B
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-2637
Mailing Address - Country:US
Mailing Address - Phone:262-457-2224
Mailing Address - Fax:262-457-2226
Practice Address - Street 1:45 HILLDALE DR STE B
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-2637
Practice Address - Country:US
Practice Address - Phone:262-457-2224
Practice Address - Fax:262-457-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty