Provider Demographics
NPI:1225322647
Name:WILSON, DANIELLE LEAH (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:LEAH
Last Name:WILSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4166 RING RD
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213-9745
Mailing Address - Country:US
Mailing Address - Phone:319-239-1193
Mailing Address - Fax:
Practice Address - Street 1:4166 RING RD
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:IA
Practice Address - Zip Code:52213-9745
Practice Address - Country:US
Practice Address - Phone:319-239-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor