Provider Demographics
NPI:1881619518
Name:WILSON, DAWN ANGELIQUE (DC)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:ANGELIQUE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DAWN
Other - Middle Name:WILSON
Other - Last Name:KENDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2020 S INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-4776
Mailing Address - Country:US
Mailing Address - Phone:757-460-7870
Mailing Address - Fax:757-460-7871
Practice Address - Street 1:2020 S INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-4776
Practice Address - Country:US
Practice Address - Phone:757-460-7870
Practice Address - Fax:757-460-7871
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV06704Medicare UPIN
VA008697K64Medicare ID - Type Unspecified