Provider Demographics
NPI:1760791214
Name:WILSON, DANIEL JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
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 1:11056 RENAISSANCE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7797
Mailing Address - Country:US
Mailing Address - Phone:678-756-0469
Mailing Address - Fax:
Practice Address - Street 1:10220 COULOAK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-7678
Practice Address - Country:US
Practice Address - Phone:704-392-9999
Practice Address - Fax:704-392-9913
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010316111N00000X
NC4260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor