Provider Demographics
NPI:1871631473
Name:WILKE, TAMMY KAY (DC)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:KAY
Last Name:WILKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S DOUTY ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5163
Mailing Address - Country:US
Mailing Address - Phone:559-584-5211
Mailing Address - Fax:559-584-5212
Practice Address - Street 1:109 S DOUTY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5163
Practice Address - Country:US
Practice Address - Phone:559-584-5211
Practice Address - Fax:559-584-5212
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6028111N00000X
CA31045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC03915Medicare UPIN