Provider Demographics
NPI:1851323190
Name:WILKS, STEPHEN CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHARLES
Last Name:WILKS
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 1:28 BELLE TRACE CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3570
Mailing Address - Country:US
Mailing Address - Phone:731-664-5550
Mailing Address - Fax:731-664-5990
Practice Address - Street 1:7 STONEBRIDGE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2021
Practice Address - Country:US
Practice Address - Phone:731-664-5550
Practice Address - Fax:731-664-5990
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor