Healthcare Provider Details

I. General information

NPI: 1992732697
Provider Name (Legal Business Name): JUDITH JULIE WILSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 SOUTHAMPTON RD
BENICIA CA
94510-1907
US

IV. Provider business mailing address

880 SOUTHAMPTON RD
BENICIA CA
94510-1907
US

V. Phone/Fax

Practice location:
  • Phone: 707-748-0880
  • Fax: 707-748-0669
Mailing address:
  • Phone: 707-748-0880
  • Fax: 707-748-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC15436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: