Healthcare Provider Details

I. General information

NPI: 1598947491
Provider Name (Legal Business Name): WILHELM CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 TALLMADGE RD
ROOTSTOWN OH
44272
US

IV. Provider business mailing address

4155 TALLMADGE RD
ROOTSTOWN OH
44272
US

V. Phone/Fax

Practice location:
  • Phone: 330-325-2575
  • Fax: 330-325-2676
Mailing address:
  • Phone: 330-325-2575
  • Fax: 330-325-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2880
License Number StateOH

VIII. Authorized Official

Name: ROGER A WILHELM JR.
Title or Position: PRES
Credential: DC
Phone: 330-325-2575