Individual
DR. KENNETH L. WILTBANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
229 S MAIN ST, SNOWFLAKE, AZ 85937-5316
(928) 536-3235
Mailing address
PO BOX 982, SNOWFLAKE, AZ 85937-0982
(928) 536-3235
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5093
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0239680
BLUE CROSS BLUE SHIELD
AZ
05
—
350050540
—
AZ
01
—
5093
LICENCE NUMBER
AZ
Enumeration date
03/27/2006
Last updated
01/26/2017
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