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General NPI Number Information
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NPI Number | 1316787286
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Entity Type | Individual
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Provider Name | CARLIE LYNN WILSON DC
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Gender | Female
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 150 LOVELL RD STE 107
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City | KNOXVILLE
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State | TN
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Zip | 37934-1900
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Country | US
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Telephone | 865-288-4568
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Fax |
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Provider Business Mailing Address
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Address Line | 1442 LAKE FOREST DR
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City | SPRING CITY
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State | TN
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Zip | 37381-4717
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Country | US
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Telephone | 423-326-9773
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Fax |
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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 | 3857
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License Number State | TN
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