Healthcare Provider Details

I. General information

NPI: 1538227400
Provider Name (Legal Business Name): SCOTT DAVID WILSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 N 1ST AVE
EVANSVILLE IN
47710-1937
US

IV. Provider business mailing address

817 N 1ST AVE
EVANSVILLE IN
47710-1937
US

V. Phone/Fax

Practice location:
  • Phone: 812-422-1380
  • Fax: 812-425-2902
Mailing address:
  • Phone: 812-422-1380
  • Fax: 812-425-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08000820A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: