Provider Demographics
NPI:1376649699
Name:WILBERT, R EILLEEN DECENA (DC)
Entity type:Individual
Prefix:DR
First Name:R EILLEEN
Middle Name:DECENA
Last Name:WILBERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 N WOODLAWN ST
Mailing Address - Street 2:STE. # 170
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3959
Mailing Address - Country:US
Mailing Address - Phone:316-683-5490
Mailing Address - Fax:316-683-0630
Practice Address - Street 1:2434 N WOODLAWN BLVD
Practice Address - Street 2:STE. # 170
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3997
Practice Address - Country:US
Practice Address - Phone:316-683-5490
Practice Address - Fax:316-683-0630
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
16-1745407OtherTAX IDENTIFICATION
KS062268Medicare ID - Type Unspecified