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General NPI Number Information
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NPI Number | 1144589458
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Entity Type | Individual
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Provider Name | ROBERT WILSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 132A N CENTRAL AVE
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City | CENTERVILLE
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State | TN
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Zip | 37033
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Country | US
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Telephone | 931-729-4001
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Fax | 931-729-4081
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Provider Business Mailing Address
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Address Line | PO BOX 99
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City | CENTERVILLE
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State | TN
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Zip | 37033-0099
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Country | US
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Telephone | 931-729-4001
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Fax | 931-729-4081
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2591
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License Number State | TN
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