Provider Demographics
NPI:1912179037
Name:WILKINSON, NANCY A (DC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:WILKINSON
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 1:5615 PERSHING AVE
Mailing Address - Street 2:#22
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-1757
Mailing Address - Country:US
Mailing Address - Phone:314-454-0566
Mailing Address - Fax:
Practice Address - Street 1:5615 PERSHING AVE
Practice Address - Street 2:#22
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-1757
Practice Address - Country:US
Practice Address - Phone:314-454-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor