Provider Demographics
NPI:1316120942
Name:WILKERSON, MARC F (DC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:F
Last Name:WILKERSON
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 1:415 E OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-6839
Mailing Address - Country:US
Mailing Address - Phone:805-736-4537
Mailing Address - Fax:805-736-8991
Practice Address - Street 1:415 E OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6839
Practice Address - Country:US
Practice Address - Phone:805-736-4537
Practice Address - Fax:805-736-8991
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T04622Medicare UPIN
DC12096Medicare PIN