=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598947491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILHELM CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2007
-----------------------------------------------------
Last Update Date | 03/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4155 TALLMADGE RD
-----------------------------------------------------
City | ROOTSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-325-2575
-----------------------------------------------------
Fax | 330-325-2676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4155 TALLMADGE RD
-----------------------------------------------------
City | ROOTSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-325-2575
-----------------------------------------------------
Fax | 330-325-2676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | ROGER A WILHELM JR.
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 330-325-2575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2880
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------