MEDICARE: DR. DONALD ROBERT WILCOX DC DABCO

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	X003252-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	350033887	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	P010003252	OTHER	EXCELLUS
2	11124949	OTHER	CAQH COALTION FOR AFFORDA
3	16118444601	OTHER	PRISM HEALTH NETWORK
5	8808985	OTHER	INDEPENDENT HEALTH
6	4662645	OTHER	AETNA INC

General Provider Information

NPI Number	:	1609854264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD ROBERT WILCOX DC DABCO

Provider Business Mailing Address
First Line	:	18 S STATE ST
Second Line	:	PO BOX 639
City	:	NUNDA
State	:	NY
Zip	:	14517-0639
Country	:	US
Telephone Number	:	585-468-3440
Fax Number	:	585-468-2835

Provider Business Practice Location Address
First Line	:	18 S STATE ST
Second Line	:
City	:	NUNDA
State	:	NY
Zip	:	14517-0639
Country	:	US
Telephone Number	:	585-468-3440
Fax Number	:	585-468-2835

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	09/10/2010

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Directions to “ DR. DONALD ROBERT WILCOX DC DABCO” Practice Location

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