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General NPI Number Information
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NPI Number | 1821263948
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Entity Type | Organization
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Legal Business Name | WILBER CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1715 BUFORD DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-3213
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Country | US
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Telephone | 770-277-1650
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Fax | 770-271-0451
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Provider Business Mailing Address
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Address Line | 1715 BUFORD DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-3213
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Country | US
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Telephone | 770-277-1650
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Fax | 770-271-0451
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. THOMAS A WILBER
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Credential | D.C.
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Telephone | 770-277-1650
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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 | 2008008890
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License Number State | GA
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