Provider Demographics
NPI:1992811061
Name:WILHELM, ROGER A JR (DC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:WILHELM
Suffix:JR
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 1:4155 TALLMADGE RD
Mailing Address - Street 2:
Mailing Address - City:ROOTSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44272
Mailing Address - Country:US
Mailing Address - Phone:330-325-2575
Mailing Address - Fax:330-325-2676
Practice Address - Street 1:4155 TALLMADGE RD
Practice Address - Street 2:
Practice Address - City:ROOTSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44272
Practice Address - Country:US
Practice Address - Phone:330-325-2575
Practice Address - Fax:330-325-2676
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2256151Medicaid
OH4052081Medicare PIN