Provider Demographics
NPI:1487731923
Name:RICHARD L WILCOX DC
Entity type:Organization
Organization Name:RICHARD L WILCOX DC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-871-6996
Mailing Address - Street 1:1958 E VINEYARD ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1715
Mailing Address - Country:US
Mailing Address - Phone:808-871-6996
Mailing Address - Fax:808-893-0866
Practice Address - Street 1:1958 E VINEYARD ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1715
Practice Address - Country:US
Practice Address - Phone:808-871-6996
Practice Address - Fax:808-893-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC384111N00000X
CA15432111N00000X
CA18844111N00000X
HIDC445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIO0094375OtherHI MEDICAL SERVICES ASSOC
HIA0065720OtherHI MEDICAL SERVICES ASSOC
HIA0065720OtherHI MEDICAL SERVICES ASSOC