Provider Demographics
NPI:1669402160
Name:GUILLORY, WILTON A III (DC)
Entity type:Individual
Prefix:DR
First Name:WILTON
Middle Name:A
Last Name:GUILLORY
Suffix:III
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 1:1226 WINDSOR PL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2748
Mailing Address - Country:US
Mailing Address - Phone:318-487-0960
Mailing Address - Fax:318-487-2002
Practice Address - Street 1:1226 WINDSOR PL
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2748
Practice Address - Country:US
Practice Address - Phone:318-487-0960
Practice Address - Fax:318-487-2002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor