Healthcare Provider Details

I. General information

NPI: 1093804155
Provider Name (Legal Business Name): ERIC ROBERT WILSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/03/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W SOUTH BOULDER RD STE 4
LOUISVILLE CO
80027-1674
US

IV. Provider business mailing address

333 W SOUTH BOULDER RD STE 4
LOUISVILLE CO
80027-1674
US

V. Phone/Fax

Practice location:
  • Phone: 720-457-9509
  • Fax:
Mailing address:
  • Phone: 720-457-9509
  • Fax: 720-457-9509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6211
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: