MEDICARE: DR. NANCY A WILKINSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	005056	MO

General Provider Information

NPI Number	:	1912179037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY A WILKINSON D.C.

Provider Business Mailing Address
First Line	:	5615 PERSHING AVE
Second Line	:	#22
City	:	SAINT LOUIS
State	:	MO
Zip	:	63112-1757
Country	:	US
Telephone Number	:	314-454-0566
Fax Number	:

Provider Business Practice Location Address
First Line	:	5615 PERSHING AVE
Second Line	:	#22
City	:	SAINT LOUIS
State	:	MO
Zip	:	63112-1757
Country	:	US
Telephone Number	:	314-454-0566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	03/28/2008

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