Provider Demographics
NPI:1649049289
Name:WILSON, MOLLY MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 RIVER BEND PARK
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-1274
Mailing Address - Country:US
Mailing Address - Phone:484-631-8217
Mailing Address - Fax:
Practice Address - Street 1:2500 CONESTOGA AVE STE 2
Practice Address - Street 2:
Practice Address - City:HONEY BROOK
Practice Address - State:PA
Practice Address - Zip Code:19344-1112
Practice Address - Country:US
Practice Address - Phone:610-450-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor