Provider Demographics
NPI:1780717785
Name:WILKEY, SAMUEL WADE (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WADE
Last Name:WILKEY
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 1:2145 NASHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-3870
Mailing Address - Country:US
Mailing Address - Phone:270-781-1111
Mailing Address - Fax:270-781-4935
Practice Address - Street 1:2145 NASHVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-3870
Practice Address - Country:US
Practice Address - Phone:270-781-1111
Practice Address - Fax:270-781-4935
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6040402Medicare ID - Type Unspecified