Provider Demographics
NPI:1417030685
Name:WILSON, EDWARD D (DC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:D
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 1:4500 HILLCREST
Mailing Address - Street 2:#160
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:972-377-4747
Mailing Address - Fax:972-377-0977
Practice Address - Street 1:4500 HILLCREST
Practice Address - Street 2:#160
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:972-377-4747
Practice Address - Fax:972-377-0977
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U65527Medicare UPIN
TX606656Medicare ID - Type Unspecified