Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH33906 | WA |
NPI | 1003931395 |
---|---|
Provider Name | Dr. Nicholas A Wilcox |
First Address | Graham, WA 98338-8411 |
Second Address | Graham, WA 98338-8411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |