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General NPI Number Information
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NPI Number | 1487728010
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Entity Type | Individual
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Provider Name | JUDITH DIANE WILSON DC
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 13169 N DUTCH LN
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City | ASHLEY
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State | IL
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Zip | 62808-4108
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Country | US
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Telephone | 618-485-6661
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Fax | 618-485-6661
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Provider Business Mailing Address
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Address Line | 13169 N DUTCH LN
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City | ASHLEY
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State | IL
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Zip | 62808-4108
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Country | US
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Telephone | 618-485-6661
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Fax | 618-485-6661
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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 | 038005940
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License Number State | IL
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