Provider Demographics
NPI:1932569704
Name:WILSON, HALEY (DC)
Entity Type:Individual
Prefix:DR
First Name:HALEY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W GOVERNMENT ST STE A1
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-3050
Mailing Address - Country:US
Mailing Address - Phone:601-527-7274
Mailing Address - Fax:601-898-0466
Practice Address - Street 1:1350 W GOVERNMENT ST STE A1
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042
Practice Address - Country:US
Practice Address - Phone:601-527-7274
Practice Address - Fax:601-898-0466
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor