Provider Demographics
NPI:1811519838
Name:WILHELM, CODY (DC)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:WILHELM
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 1:29 CANYON VIEW RD
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-6012
Mailing Address - Country:US
Mailing Address - Phone:208-203-3155
Mailing Address - Fax:
Practice Address - Street 1:1505 MADRONA ST N # 900C
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8318
Practice Address - Country:US
Practice Address - Phone:208-203-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-2005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor