Provider Demographics
NPI:1013731918
Name:WILKES, QUIN NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:QUIN
Middle Name:NICOLE
Last Name:WILKES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 TAZEWELL DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7149
Mailing Address - Country:US
Mailing Address - Phone:618-910-0550
Mailing Address - Fax:
Practice Address - Street 1:13470 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1006
Practice Address - Country:US
Practice Address - Phone:314-809-4129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024043657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor