Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC008014L | PA |
N | 111NS0005X | Chiropractic Sports Physician | DC008014L | PA |
NPI | 1003877507 |
---|---|
Provider Name | Dr. Gregory D Wilson |
First Address | Mount Pleasant, PA 15666-1846 |
Second Address | Mount Pleasant, PA 15666-1846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2006 |
Last Update Date | 19/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U91326 | (02) | PA |