Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 12578 | CA |
Y | 111NI0013X | Independent Medical Examiner | 12578 | CA |
NPI | 1356515860 |
---|---|
Provider Name | Robert L Wilcox |
First Address | Folsom, CA 95630-2375 |
Second Address | Folsom, CA 95630-2375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2008 |
Last Update Date | 15/04/2008 |