Provider Demographics
NPI:1104088111
Name:SHILOH D WIHKSNE BSC DC LLC
Entity type:Organization
Organization Name:SHILOH D WIHKSNE BSC DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHILOH
Authorized Official - Middle Name:D
Authorized Official - Last Name:WIHKSNE
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, DC, LLC
Authorized Official - Phone:503-650-2487
Mailing Address - Street 1:21400 S SALAMO RD
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-7201
Mailing Address - Country:US
Mailing Address - Phone:503-650-2487
Mailing Address - Fax:503-650-4382
Practice Address - Street 1:21400 S SALAMO RD
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-7201
Practice Address - Country:US
Practice Address - Phone:503-650-2487
Practice Address - Fax:503-650-4382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR133056Medicare PIN