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NPI Code Detail

MEDICARE: DR. DANIEL JAMES WILSON D.C.

MEDICARE: DR. DANIEL JAMES WILSON D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorDC010316PA
2111N00000XChiropractor4260NC

General Provider Information

NPI Number : 1760791214
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL JAMES WILSON D.C.
Provider Business Mailing Address
First Line : 11056 RENAISSANCE DR
Second Line :
City : DAVIDSON
State : NC
Zip : 28036-7797
Country : US
Telephone Number : 678-756-0469
Fax Number :
Provider Business Practice Location Address
First Line : 10220 COULOAK DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28216-7678
Country : US
Telephone Number : 704-392-9999
Fax Number : 704-392-9913
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2010
Last Update Date : 01/20/2020

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