Provider Demographics
NPI:1831212729
Name:WILSON, WARREN WINSLOW (DC)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:WINSLOW
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 1:506 LIMESTONE DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-3617
Mailing Address - Country:US
Mailing Address - Phone:817-368-4400
Mailing Address - Fax:817-545-5260
Practice Address - Street 1:506 LIMESTONE DR
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-3617
Practice Address - Country:US
Practice Address - Phone:817-368-4400
Practice Address - Fax:817-545-5260
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9222111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation