Provider Demographics
NPI:1851326995
Name:WILCHEK, GARRETT (DC)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:WILCHEK
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:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-0364
Mailing Address - Country:US
Mailing Address - Phone:714-375-4800
Mailing Address - Fax:714-375-4801
Practice Address - Street 1:17822 BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7161
Practice Address - Country:US
Practice Address - Phone:714-375-4800
Practice Address - Fax:714-375-4801
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27886AMedicare ID - Type Unspecified