Provider Demographics
NPI:1306828264
Name:WILSON, SHARON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LEE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:LEE
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771
Mailing Address - Country:US
Mailing Address - Phone:508-336-8100
Mailing Address - Fax:
Practice Address - Street 1:370 TAUNTON AVE
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-5245
Practice Address - Country:US
Practice Address - Phone:401-433-2100
Practice Address - Fax:508-448-5577
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007008900Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE
RIU844557Medicare UPIN