Provider Demographics
NPI:1790736387
Name:WIHKSNE, SHILOH D (DC, LLC)
Entity Type:Individual
Prefix:DR
First Name:SHILOH
Middle Name:D
Last Name:WIHKSNE
Suffix:
Gender:F
Credentials:DC, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21400 S SALAMO RD
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-7201
Mailing Address - Country:US
Mailing Address - Phone:503-650-2487
Mailing Address - Fax:503-650-4382
Practice Address - Street 1:21400 S SALAMO RD
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-7201
Practice Address - Country:US
Practice Address - Phone:503-650-2487
Practice Address - Fax:503-650-4382
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR800021196OtherTAX ID
OR800021196OtherTAX ID
OR133057Medicare ID - Type Unspecified