Doctor Name: | MARK WILSON |
NPI Number: | 1700950771 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | 826 |
Business Practice Address: | 2300 Great Northern Ave Ste B Missoula, MT - 598081726 |
Business Phone Number: | 4065499100 |
Business Fax Number: | 4065499151 |
Mailing Address: | 2300 Great Northern Ave Ste B, MISSOULA |
State: | MT |
Postal Code: | 598081726 |
Phone Number: | 4065499100 |
Fax Number: | 4065499151 |
NPI Enumeration Date: | 11/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 826 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |