MEDICARE: DR. JOHN W WILKE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	01321	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407945637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN W WILKE D.C.

Provider Business Mailing Address
First Line	:	400 EAST ST
Second Line	:	STE 101
City	:	WILTON
State	:	WI
Zip	:	54670-7735
Country	:	US
Telephone Number	:	608-463-7754
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 EAST ST
Second Line	:	STE 101
City	:	WILTON
State	:	WI
Zip	:	54670-7735
Country	:	US
Telephone Number	:	608-435-6290
Fax Number	:	608-435-6293

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	04/11/2013

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