Provider Demographics
NPI:1760513279
Name:WILKINS, JEREMY C (DC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:C
Last Name:WILKINS
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 1:605 NORTH CHURCH ST.
Mailing Address - Street 2:
Mailing Address - City:MT. PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1000
Mailing Address - Country:US
Mailing Address - Phone:724-542-4252
Mailing Address - Fax:724-542-4254
Practice Address - Street 1:605 NORTH CHURCH ST.
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1000
Practice Address - Country:US
Practice Address - Phone:724-542-4252
Practice Address - Fax:724-542-4254
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014014190001Medicaid