Provider Demographics
NPI:1669679239
Name:WILSON, DARA RENA (DC)
Entity Type:Individual
Prefix:DR
First Name:DARA
Middle Name:RENA
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 1:1109 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6747
Mailing Address - Country:US
Mailing Address - Phone:410-578-3993
Mailing Address - Fax:
Practice Address - Street 1:2810 WALTERS LN
Practice Address - Street 2:SUITE 14
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-3247
Practice Address - Country:US
Practice Address - Phone:301-420-8888
Practice Address - Fax:301-420-8838
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02081111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation