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General NPI Number Information
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NPI Number | 1194088021
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Entity Type | Individual
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Provider Name | AARON J WILSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 356 S MCCULLOCH BLVD STE 106
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City | PUEBLO WEST
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State | CO
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Zip | 81007-2848
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Country | US
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Telephone | 719-647-2206
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Fax | 719-647-8866
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Provider Business Mailing Address
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Address Line | 50 S DUNLAP DR
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City | PUEBLO WEST
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State | CO
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Zip | 81007
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Country | US
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Telephone | 719-547-2068
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Fax | 719-547-2782
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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 | 6831
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License Number State | CO
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