Provider Demographics
NPI:1285783738
Name:WILMOVSKY, BRIAN L (DC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:L
Last Name:WILMOVSKY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2627 CAPITOL MALL DR SW STE B3A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8696
Mailing Address - Country:US
Mailing Address - Phone:360-786-6322
Mailing Address - Fax:360-786-5677
Practice Address - Street 1:2627 CAPITOL MALL DR SW STE B3A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8696
Practice Address - Country:US
Practice Address - Phone:360-786-6322
Practice Address - Fax:360-786-5677
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor