MEDICARE: MS. JUDITH JULIE WILSON D.C.

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	DC15436	CA

General Provider Information

NPI Number	:	1992732697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH JULIE WILSON D.C.

Provider Business Mailing Address
First Line	:	880 SOUTHAMPTON RD
Second Line	:
City	:	BENICIA
State	:	CA
Zip	:	94510-1907
Country	:	US
Telephone Number	:	707-748-0880
Fax Number	:	707-748-0669

Provider Business Practice Location Address
First Line	:	880 SOUTHAMPTON RD
Second Line	:
City	:	BENICIA
State	:	CA
Zip	:	94510-1907
Country	:	US
Telephone Number	:	707-748-0880
Fax Number	:	707-748-0669

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	07/09/2007

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