Provider Demographics
NPI:1447303441
Name:WILBUR, FRANK RAY (DC)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:RAY
Last Name:WILBUR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:F
Other - Last Name:WILBUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3510 UNOCAL PL
Mailing Address - Street 2:STE 209
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-0918
Mailing Address - Country:US
Mailing Address - Phone:707-284-9200
Mailing Address - Fax:707-284-9204
Practice Address - Street 1:3510 UNOCAL PL
Practice Address - Street 2:STE 209
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-0918
Practice Address - Country:US
Practice Address - Phone:707-284-9200
Practice Address - Fax:707-284-9204
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68-0371927OtherTAX ID#
CADC16087OtherLICENSE #
CAT06018Medicare UPIN
CADC0160870Medicare ID - Type UnspecifiedMEDICARE #