Provider Demographics
NPI:1558520742
Name:WILISON FAMILY CHIROPRACTICS, LTD
Entity Type:Organization
Organization Name:WILISON FAMILY CHIROPRACTICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-485-6661
Mailing Address - Street 1:13169 N DUTCH LN
Mailing Address - Street 2:
Mailing Address - City:ASHLEY
Mailing Address - State:IL
Mailing Address - Zip Code:62808-4108
Mailing Address - Country:US
Mailing Address - Phone:618-485-6661
Mailing Address - Fax:618-485-6661
Practice Address - Street 1:13169 N DUTCH LN
Practice Address - Street 2:
Practice Address - City:ASHLEY
Practice Address - State:IL
Practice Address - Zip Code:62808-4108
Practice Address - Country:US
Practice Address - Phone:618-485-6661
Practice Address - Fax:618-485-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38005940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty