MEDICARE: JEANNECE WILSON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	14007	TX

General Provider Information

NPI Number	:	1265087928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNECE WILSON DC

Provider Business Mailing Address
First Line	:	5625 FM 1960 RD W STE 504
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-4212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5625 FM 1960 RD W STE 504
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-4212
Country	:	US
Telephone Number	:	281-836-6550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	08/08/2019

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Directions to “ JEANNECE WILSON DC” Practice Location

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