Provider Demographics
NPI:1023451465
Name:WILSON, NICKOLAS S (DC)
Entity type:Individual
Prefix:DR
First Name:NICKOLAS
Middle Name:S
Last Name:WILSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:2456 LAKE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-4219
Mailing Address - Country:US
Mailing Address - Phone:317-626-2700
Mailing Address - Fax:317-844-8130
Practice Address - Street 1:3940 W 96TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2922
Practice Address - Country:US
Practice Address - Phone:317-749-0677
Practice Address - Fax:317-735-8753
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2024-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN08002708A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor