MEDICARE: WILTON A GUILLORY III, DC, LLC

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	1409	LA

General Provider Information

NPI Number	:	1831268333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILTON A GUILLORY III, DC, LLC

Provider Business Mailing Address
First Line	:	1226 WINDSOR PL
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2748
Country	:	US
Telephone Number	:	318-487-0960
Fax Number	:	318-487-2002

Provider Business Practice Location Address
First Line	:	1226 WINDSOR PL
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2748
Country	:	US
Telephone Number	:	318-487-0960
Fax Number	:	318-487-2002

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. WILTON A GUILLORY III
Credential	:	D.C.
Telephone Number	:	318-487-0960

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	10/15/2007

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