Provider Demographics
NPI:1245943653
Name:WRISTEN, WILLIAM VERNON (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:VERNON
Last Name:WRISTEN
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 1:509 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2208
Mailing Address - Country:US
Mailing Address - Phone:925-783-2535
Mailing Address - Fax:
Practice Address - Street 1:509 W 18TH ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2208
Practice Address - Country:US
Practice Address - Phone:925-783-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor