Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1840 | OR |
NPI | 1255497319 |
---|---|
Provider Name | Dr. Jim I Wilkens |
First Address | Bend, OR 97701-4607 |
Second Address | Bend, OR 97701-4607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2006 |
Last Update Date | 08/07/2007 |