Lolita a. Wilburn D.C.P.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038007208 Issued in IL

Legal business name

LOLITA A. WILBURN D.C.P.C.

Practice address

12647 S Justine St
Calumet Park, IL 60827-6009

Phone

(708) 489-2225

Fax

(798) 489-2610

NPI assigned

Jul 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lolita A Wilburn, D.C

Title

Director

Phone

(708) 489-2225

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Back To Heatlh Chiropractic-Medical Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233619200000",
    "number": "1619174653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12647 S JUSTINE ST",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "608276009",
            "telephone_number": "708-489-2225",
            "fax_number": "798-489-2610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12647 S JUSTINE ST",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "608276009",
            "telephone_number": "708-489-2225",
            "fax_number": "798-489-2610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOLITA A. WILBURN D.C.P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-02",
        "last_updated": "2009-02-03",
        "status": "A",
        "authorized_official_last_name": "WILBURN",
        "authorized_official_first_name": "LOLITA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "708-489-2225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038007208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSSBLUE SHIELD",
            "identifier": "01622136",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038007208",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Back To Heatlh Chiropractic-Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Calumet Park, IL
• Providers in Calumet Park, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.