Provider Demographics
NPI:1679268650
Name:WILSON, JAMES LESLIE (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LESLIE
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 1:4142 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1942
Mailing Address - Country:US
Mailing Address - Phone:520-235-7178
Mailing Address - Fax:520-327-0038
Practice Address - Street 1:4142 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1942
Practice Address - Country:US
Practice Address - Phone:520-235-7178
Practice Address - Fax:520-327-0038
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor