Provider Demographics
NPI:1750570925
Name:WILSON, WILLIAM H (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
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 1:3701 DIVISION ST
Mailing Address - Street 2:SUITE 131
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4617
Mailing Address - Country:US
Mailing Address - Phone:985-710-2645
Mailing Address - Fax:
Practice Address - Street 1:3701 DIVISION ST
Practice Address - Street 2:SUITE 131
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4617
Practice Address - Country:US
Practice Address - Phone:985-710-2645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA854OtherSTATE LICENSE
LA56335Medicare PIN