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General NPI Number Information
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NPI Number | 1588936801
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Entity Type | Individual
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Provider Name | TIMOTHY JOSEPH WILSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 8357 N RAMPART RANGE RD SUITE 205
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City | LITTLETON
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State | CO
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Zip | 80125-9365
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Country | US
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Telephone | 303-932-0081
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Fax |
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Provider Business Mailing Address
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Address Line | 4610 W MINERAL DR UNIT 1328
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City | LITTLETON
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State | CO
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Zip | 80128-2582
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Country | US
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Telephone | 970-631-2844
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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 | 6774
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2011037863
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License Number State | MO
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