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General NPI Number Information
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NPI Number | 1861928145
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Entity Type | Individual
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Provider Name | JUSTIN WILCOX
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Gender | Male
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 838 G ST
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City | SAN DIEGO
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State | CA
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Zip | 92101
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Country | US
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Telephone | 619-786-5997
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 ISLAND AVE UNIT 309
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City | SAN DIEGO
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State | CA
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Zip | 92101-7260
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Country | US
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Telephone | 813-469-0409
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CHR.0007606
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | EL.2786658
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 34234
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License Number State | CA
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