Provider Demographics
NPI:1194872309
Name:WILKINSON, ROBERT L (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:WILKINSON
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 1:411 ATLAS ST
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3118
Mailing Address - Country:US
Mailing Address - Phone:714-672-9690
Mailing Address - Fax:714-672-9692
Practice Address - Street 1:411 ATLAS ST
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3118
Practice Address - Country:US
Practice Address - Phone:714-672-9690
Practice Address - Fax:714-672-9692
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 21168A111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation