Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 08001636A | IN |
NPI | 1366513475 |
---|---|
Provider Name | Dr. Sheila Lanell Wilson |
First Address | Indianapolis, IN 46254-1652 |
Second Address | Indianapolis, IN 46254-1652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2006 |
Last Update Date | 01/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200131080 A | (05) | IN |
U66212 | (02) | IN |