Provider Demographics
NPI:1457142200
Name:WILSON, MARINA E (DC, MSFN)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:E
Last Name:WILSON
Suffix:
Gender:F
Credentials:DC, MSFN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7145
Mailing Address - Country:US
Mailing Address - Phone:817-899-4328
Mailing Address - Fax:
Practice Address - Street 1:2912 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4995
Practice Address - Country:US
Practice Address - Phone:469-565-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16343111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition