Provider Demographics
NPI:1457089757
Name:WILKINSON, COLE (DC)
Entity Type:Individual
Prefix:DR
First Name:COLE
Middle Name:
Last Name:WILKINSON
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 1:7250 CARTER RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:LA
Mailing Address - Zip Code:70581-3108
Mailing Address - Country:US
Mailing Address - Phone:512-897-3925
Mailing Address - Fax:
Practice Address - Street 1:721 BAYOU PINES EAST DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7183
Practice Address - Country:US
Practice Address - Phone:337-478-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-13
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor