Healthcare Provider Details

I. General information

NPI: 1487731923
Provider Name (Legal Business Name): RICHARD L WILCOX DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1958 E VINEYARD ST
WAILUKU HI
96793-1715
US

IV. Provider business mailing address

1958 E VINEYARD ST
WAILUKU HI
96793-1715
US

V. Phone/Fax

Practice location:
  • Phone: 808-871-6996
  • Fax: 808-893-0866
Mailing address:
  • Phone: 808-871-6996
  • Fax: 808-893-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC384
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15432
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number18844
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC445
License Number StateHI

VIII. Authorized Official

Name: DR. RICHARD L WILCOX
Title or Position: OWNER
Credential: DC
Phone: 808-871-6996