Provider Demographics
NPI:1548377716
Name:WILBURN, LOLITA A (DC)
Entity type:Individual
Prefix:DR
First Name:LOLITA
Middle Name:A
Last Name:WILBURN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LOLITA
Other - Middle Name:A
Other - Last Name:WILBURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC PC
Mailing Address - Street 1:12647 S JUSTINE
Mailing Address - Street 2:
Mailing Address - City:CALUMET PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60827
Mailing Address - Country:US
Mailing Address - Phone:708-489-2225
Mailing Address - Fax:708-489-2610
Practice Address - Street 1:12647 S JUSTINE
Practice Address - Street 2:
Practice Address - City:CALUMET PARK
Practice Address - State:IL
Practice Address - Zip Code:60827
Practice Address - Country:US
Practice Address - Phone:708-489-2225
Practice Address - Fax:708-489-2610
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
01622136OtherBCBS
01622136OtherBCBS