Provider Demographics
NPI:1295067197
Name:WILSON, ZACHARIAH LEIGH (DC)
Entity type:Individual
Prefix:
First Name:ZACHARIAH
Middle Name:LEIGH
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 1:5100 HIGHBRIDGE ST
Mailing Address - Street 2:APT. 47E
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2411
Mailing Address - Country:US
Mailing Address - Phone:307-399-1807
Mailing Address - Fax:
Practice Address - Street 1:36 F CATOCTIN CIRCLE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-1089
Practice Address - Country:US
Practice Address - Phone:703-777-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011950-1111N00000X
VA0104557288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor