Provider Demographics
NPI:1669702973
Name:WILSTEAD, JOEL (DC)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:WILSTEAD
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 1:410 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-6025
Mailing Address - Country:US
Mailing Address - Phone:816-519-5960
Mailing Address - Fax:
Practice Address - Street 1:2709 PALMER HWY
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-6929
Practice Address - Country:US
Practice Address - Phone:409-948-1000
Practice Address - Fax:409-948-1005
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13341111N00000X
OHDC.4393111N00000X
CA31490111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO750001546Medicaid
MOMA3421001Medicare UPIN
MOP01044202OtherRAILROAD MEDICARE