Provider Demographics
NPI:1992839252
Name:WILVERT, WESLEY E (DC)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:E
Last Name:WILVERT
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 1:486 BANKHEAD HWY
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-2445
Mailing Address - Country:US
Mailing Address - Phone:770-834-7477
Mailing Address - Fax:770-834-3648
Practice Address - Street 1:486 BANKHEAD HWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-2445
Practice Address - Country:US
Practice Address - Phone:770-834-7477
Practice Address - Fax:770-834-3648
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1135111N00000X
CO1944111N00000X
CA12101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor