Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH00033638 | WA |
N | 111NR0400X | Rehabilitation Chiropractor | CH00033638 | WA |
NPI | 1174616999 |
---|---|
Provider Name | Dr. Steven Joseph Wilson |
First Address | Dupont, WA 98327-8773 |
Second Address | Dupont, WA 98327-8773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 25/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1366637233 | GROUP NPI (01) | WA |
2026177 | (05) | WA |
488578 | (02) | WA |
8801606 | GROUP MEDICARE (01) | WA |