Provider Demographics
NPI:1134223530
Name:WILKEN, LONNY L (DC)
Entity type:Individual
Prefix:
First Name:LONNY
Middle Name:L
Last Name:WILKEN
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 1:2416 18TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4832
Mailing Address - Country:US
Mailing Address - Phone:563-355-0010
Mailing Address - Fax:563-355-2905
Practice Address - Street 1:2415 18TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-0202
Practice Address - Country:US
Practice Address - Phone:563-355-0010
Practice Address - Fax:563-355-2905
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0169003Medicaid
IA16900OtherBCBS
IA16900OtherBCBS