Provider Demographics
NPI:1972643054
Name:WAKOLBINGER, GREGORY F (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:WAKOLBINGER
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 1:71 S MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-3187
Mailing Address - Country:US
Mailing Address - Phone:847-229-0808
Mailing Address - Fax:847-229-1163
Practice Address - Street 1:71 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3187
Practice Address - Country:US
Practice Address - Phone:847-229-0808
Practice Address - Fax:847-229-1163
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU96829Medicare UPIN
ILK27522Medicare ID - Type Unspecified