Provider Demographics
NPI:1477338739
Name:WILSON CHIROPRACTIC THERAPY PLLC
Entity Type:Organization
Organization Name:WILSON CHIROPRACTIC THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-446-9058
Mailing Address - Street 1:16104 SEXTON CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1204
Mailing Address - Country:US
Mailing Address - Phone:813-446-9058
Mailing Address - Fax:
Practice Address - Street 1:8903 REGENTS PARK DR STE 140
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3083
Practice Address - Country:US
Practice Address - Phone:813-847-3403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON CHIROPRACTIC THERAPY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty