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General NPI Number Information
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NPI Number | 1619174653
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Entity Type | Organization
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Legal Business Name | LOLITA A. WILBURN D.C.P.C.
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 12647 S JUSTINE ST
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City | CALUMET PARK
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State | IL
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Zip | 60827-6009
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Country | US
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Telephone | 708-489-2225
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Fax | 798-489-2610
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Provider Business Mailing Address
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Address Line | 12647 S JUSTINE ST
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City | CALUMET PARK
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State | IL
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Zip | 60827-6009
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Country | US
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Telephone | 708-489-2225
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Fax | 798-489-2610
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. LOLITA A WILBURN
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Credential | D.C
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Telephone | 708-489-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038007208
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License Number State | IL
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