Provider Demographics
NPI:1023209590
Name:ROBERT E. WILSON
Entity Type:Organization
Organization Name:ROBERT E. WILSON
Other - Org Name:1ST CHOICE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-558-8222
Mailing Address - Street 1:164 GEORGE WASHINGTON HWY S
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-1701
Mailing Address - Country:US
Mailing Address - Phone:757-558-8222
Mailing Address - Fax:757-558-8225
Practice Address - Street 1:164 GEORGE WASHINGTON HWY S
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-1701
Practice Address - Country:US
Practice Address - Phone:757-558-8222
Practice Address - Fax:757-558-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA287393OtherANTHEM BC/BS
VAC07066Medicare PIN