=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356738298
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MWILKE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2015
-----------------------------------------------------
Last Update Date | 08/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2075 BLACKBERRY DR STE B
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60134-4716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-723-8983
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2075 BLACKBERRY DR STE B
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60134-4716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-723-8983
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. MELISSA D WILKE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 630-723-8983
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038009608
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------