Provider Demographics
NPI:1770779357
Name:BEBEE-WILSON, J S (DC)
Entity type:Individual
Prefix:DR
First Name:J
Middle Name:S
Last Name:BEBEE-WILSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:J
Other - Middle Name:SCOTT
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2232 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2617
Mailing Address - Country:US
Mailing Address - Phone:215-235-9540
Mailing Address - Fax:215-232-4903
Practice Address - Street 1:2232 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2617
Practice Address - Country:US
Practice Address - Phone:215-235-9540
Practice Address - Fax:215-232-4903
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004809L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA688610Medicare PIN