NPIMap

Organization Active NPI

Robert Wilson, DC, PLLC

Doing business as Life Source of Centerville

  • Clinic/Center
  • Centerville, TN
National Provider Identifier
1366957656
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ROBERT WILSON, DC, PLLC
Doing business as
Life Source of Centerville
Practice address
132A N Central Ave
Centerville, TN 37033
Phone
(931) 729-4001
Fax
(931) 729-4081
NPI assigned
Dec 7, 2017
Last updated
Jun 11, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert E Wilson, DCNPI 1144589458
Title
Sole Owner
Phone
(931) 729-4001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

132A N Central Ave
Centerville, TN 37033

Mailing address

PO Box 99
Centerville, TN 37033-0099
Phone (931) 729-4001

Other names 1

  • Life Source of Centerville Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528675200000",
    "number": "1366957656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99",
            "city": "CENTERVILLE",
            "state": "TN",
            "postal_code": "370330099",
            "telephone_number": "931-729-4001",
            "fax_number": "931-729-4081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132A N CENTRAL AVE",
            "city": "CENTERVILLE",
            "state": "TN",
            "postal_code": "37033",
            "telephone_number": "931-729-4001",
            "fax_number": "931-729-4081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT WILSON, DC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-07",
        "last_updated": "2018-06-11",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "931-729-4001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Source of Centerville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centerville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.