Provider Demographics
NPI:1922433838
Name:WILKS CHIROPRACTIC CENTER, PLLC
Entity Type:Organization
Organization Name:WILKS CHIROPRACTIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WILKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:731-664-5550
Mailing Address - Street 1:7 STONEBRIDGE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2021
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU82691Medicare UPIN
TN3971532Medicare PIN