Healthcare Provider Details

I. General information

NPI: 1366513475
Provider Name (Legal Business Name): SHEILA LANELL WILSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5637 W 56TH ST
INDIANAPOLIS IN
46254-1652
US

IV. Provider business mailing address

5637 W 56TH ST
INDIANAPOLIS IN
46254-1652
US

V. Phone/Fax

Practice location:
  • Phone: 317-297-8800
  • Fax: 317-297-9850
Mailing address:
  • Phone: 317-297-8800
  • Fax: 317-297-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number08001636A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: