Provider Demographics
NPI:1124162599
Name:WILKENS, GREG A (DC)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:A
Last Name:WILKENS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E 17TH AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-5566
Mailing Address - Country:US
Mailing Address - Phone:620-663-5364
Mailing Address - Fax:
Practice Address - Street 1:510 E 17TH AVE
Practice Address - Street 2:SUITE H
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-5566
Practice Address - Country:US
Practice Address - Phone:620-663-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-3473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS007204Medicare ID - Type Unspecified