Provider Demographics
NPI:1174601033
Name:WILKE, SCOTT ANTHONY (DC MHA)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANTHONY
Last Name:WILKE
Suffix:
Gender:M
Credentials:DC MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4490 DERR ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503
Mailing Address - Country:US
Mailing Address - Phone:937-399-6782
Mailing Address - Fax:937-390-6782
Practice Address - Street 1:4490 DERR ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503
Practice Address - Country:US
Practice Address - Phone:937-399-6782
Practice Address - Fax:937-390-6782
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWI0786741Medicare ID - Type Unspecified
U56809Medicare UPIN