Provider Demographics
NPI:1851514400
Name:WILSON, JOE H
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:H
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5139
Mailing Address - Country:US
Mailing Address - Phone:337-948-1856
Mailing Address - Fax:337-948-1262
Practice Address - Street 1:215 S MARKET ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5139
Practice Address - Country:US
Practice Address - Phone:337-948-1856
Practice Address - Fax:337-948-1262
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor