Healthcare Provider Details

I. General information

NPI: 1073768784
Provider Name (Legal Business Name): JOHN WILLIAM WILCOX D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 148TH AVE NE SUITE 2
BELLEVUE WA
98007
US

IV. Provider business mailing address

41 148TH AVE NE
BELLEVUE WA
98007
US

V. Phone/Fax

Practice location:
  • Phone: 425-643-4484
  • Fax:
Mailing address:
  • Phone: 425-643-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH 1821
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: