Provider Demographics
NPI:1225080534
Name:WILSON, F DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:F
Middle Name:DOUGLAS
Last Name:WILSON
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 1:7301 NE HWY 99
Mailing Address - Street 2:SUITE 7
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665
Mailing Address - Country:US
Mailing Address - Phone:360-573-4666
Mailing Address - Fax:360-573-4668
Practice Address - Street 1:7301 NE HWY 99
Practice Address - Street 2:SUITE 7
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665
Practice Address - Country:US
Practice Address - Phone:360-573-4666
Practice Address - Fax:360-573-4668
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2004810Medicaid
WA8855967Medicare ID - Type Unspecified
WA2004810Medicaid