Provider Demographics
NPI:1780861963
Name:WILTON, CASEY ALAN (DC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:ALAN
Last Name:WILTON
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 1:23006 172ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4713
Mailing Address - Country:US
Mailing Address - Phone:253-332-4362
Mailing Address - Fax:
Practice Address - Street 1:23006 172ND AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-4713
Practice Address - Country:US
Practice Address - Phone:253-332-4362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor