MEDICARE: JENNIFER SUSAN WILHELM 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	DC 30131	CA

General Provider Information

NPI Number	:	1538380704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SUSAN WILHELM D.C.

Provider Business Mailing Address
First Line	:	4223 PIEDMONT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611
Country	:	US
Telephone Number	:	510-457-5874
Fax Number	:	510-653-4537

Provider Business Practice Location Address
First Line	:	2121 NE HALSEY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1522
Country	:	US
Telephone Number	:	503-836-7724
Fax Number	:	503-479-5411

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	09/03/2019

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