Provider Demographics
NPI:1174562458
Name:WILBECK, TIMOTHY R (DC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:R
Last Name:WILBECK
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 1:455 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2231
Mailing Address - Country:US
Mailing Address - Phone:316-722-2222
Mailing Address - Fax:316-729-4416
Practice Address - Street 1:455 S RIDGE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2231
Practice Address - Country:US
Practice Address - Phone:316-722-2222
Practice Address - Fax:316-729-4416
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100209980AMedicaid
KS100209980AMedicaid
KST71300Medicare UPIN