Healthcare Provider Details

I. General information

NPI: 1609854264
Provider Name (Legal Business Name): DONALD ROBERT WILCOX DC DABCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 S STATE ST
NUNDA NY
14517-0639
US

IV. Provider business mailing address

18 S STATE ST PO BOX 639
NUNDA NY
14517-0639
US

V. Phone/Fax

Practice location:
  • Phone: 585-468-3440
  • Fax: 585-468-2835
Mailing address:
  • Phone: 585-468-3440
  • Fax: 585-468-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX003252-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: