Provider Demographics
NPI:1013975440
Name:WILCOX, KENT GUY (DC)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:GUY
Last Name:WILCOX
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 1:527 SE BASELINE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4149
Mailing Address - Country:US
Mailing Address - Phone:503-640-3943
Mailing Address - Fax:503-640-9546
Practice Address - Street 1:527 SE BASELINE ST
Practice Address - Street 2:SUITE D
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4149
Practice Address - Country:US
Practice Address - Phone:503-640-3943
Practice Address - Fax:503-640-9546
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGCWKMedicare ID - Type Unspecified
ORT68262Medicare UPIN