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General NPI Number Information
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NPI Number | 1922350321
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Entity Type | Individual
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Provider Name | JARED LANE WILSON DC
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Gender | Male
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 8611 N DIVISION ST STE A
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City | SPOKANE
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State | WA
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Zip | 99208-5946
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Country | US
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Telephone | 509-599-2766
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Fax |
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Provider Business Mailing Address
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Address Line | 3009 W DALTON AVE
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City | SPOKANE
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State | WA
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Zip | 99205-2220
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Country | US
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Telephone | 509-599-2766
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | CH60542353
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License Number State | WA
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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 | CH60542353
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | CH60542353
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License Number State | WA
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