Provider Demographics
NPI:1952653990
Name:WILSON, JAMES TIMOTHY II (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TIMOTHY
Last Name:WILSON
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1540 APPLING CARE LANE
Mailing Address - Street 2:STE 105
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4947
Mailing Address - Country:US
Mailing Address - Phone:901-444-3950
Mailing Address - Fax:901-444-3866
Practice Address - Street 1:1540 APPLING CARE LANE
Practice Address - Street 2:STE 105
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-4947
Practice Address - Country:US
Practice Address - Phone:901-444-3950
Practice Address - Fax:901-444-3866
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2015-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN2633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I354807Medicare PIN