Provider Demographics
NPI:1881829273
Name:WILKINSON, PHILLIP HAROLD (DC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:HAROLD
Last Name:WILKINSON
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 1:118 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1891
Mailing Address - Country:US
Mailing Address - Phone:815-791-4089
Mailing Address - Fax:
Practice Address - Street 1:118 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1891
Practice Address - Country:US
Practice Address - Phone:815-791-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor