Healthcare Provider Details

I. General information

NPI: 1770779357
Provider Name (Legal Business Name): J S BEBEE-WILSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: J SCOTT WILSON D.C.

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 FAIRMOUNT AVE
PHILADELPHIA PA
19130-2617
US

IV. Provider business mailing address

2232 FAIRMOUNT AVE
PHILADELPHIA PA
19130-2617
US

V. Phone/Fax

Practice location:
  • Phone: 215-235-9540
  • Fax: 215-232-4903
Mailing address:
  • Phone: 215-235-9540
  • Fax: 215-232-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC004809L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: