Provider Demographics
NPI:1336386812
Name:WILSON, NATALIE KING (DC)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:KING
Last Name:WILSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NATALIE
Other - Middle Name:MARIE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:909 ELECTRIC AVE
Mailing Address - Street 2:#305
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6336
Mailing Address - Country:US
Mailing Address - Phone:562-665-1479
Mailing Address - Fax:562-493-8437
Practice Address - Street 1:909 ELECTRIC AVE
Practice Address - Street 2:#305
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6336
Practice Address - Country:US
Practice Address - Phone:562-665-1479
Practice Address - Fax:562-493-8437
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31104111N00000X
CADC31104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336386812Medicare UPIN