Provider Demographics
NPI:1356515860
Name:WILCOX, ROBERT L (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
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 1:815 WILLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2375
Mailing Address - Country:US
Mailing Address - Phone:916-983-4067
Mailing Address - Fax:916-983-2170
Practice Address - Street 1:815 WILLOW CREEK DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2375
Practice Address - Country:US
Practice Address - Phone:916-983-4067
Practice Address - Fax:916-983-2170
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12578111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111N00000XChiropractic ProvidersChiropractor