Provider Demographics
NPI:1336100304
Name:WILSON, PAULA J (DC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:J
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 1:1201 EAST BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332
Mailing Address - Country:US
Mailing Address - Phone:856-327-2225
Mailing Address - Fax:856-327-2228
Practice Address - Street 1:1201 EAST BROAD STREET
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332
Practice Address - Country:US
Practice Address - Phone:856-327-2225
Practice Address - Fax:856-327-2228
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
213209YD9EMedicare PIN
U53334Medicare UPIN