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General NPI Number Information
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NPI Number | 1619320504
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Entity Type | Organization
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Legal Business Name | WILKE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 45 HILLDALE DR STE B
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City | HARTFORD
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State | WI
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Zip | 53027-2637
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Country | US
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Telephone | 262-457-2224
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Fax | 262-457-2226
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Provider Business Mailing Address
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Address Line | 45 HILLDALE DR STE B
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City | HARTFORD
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State | WI
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Zip | 53027-2637
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Country | US
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Telephone | 262-457-2224
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Fax | 262-457-2226
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Authorized Official
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Title or Position | SOLE OWNER
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Name | JAMES A WILKE
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Credential | D.C.
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Telephone | 262-457-2224
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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 |
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License Number State |
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