Judith Diane Wilson, DC
Individual provider Active NPI Chiropractor · Ashley, IL
NPI 1487728010 · NPPES record last updated Jun 3, 2008
Key facts
- NPI
- 1487728010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038005940 (IL)
- Practice address
- 13169 N Dutch LN
Ashley, IL 62808-4108 - Phone
- (618) 485-6661
- Fax
- (618) 485-6661
- NPI assigned
- Nov 17, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wilison Family Chiropractics, LTD | Chiropractor | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038005940 | IL | Yes |
Addresses
Primary practice location
13169 N Dutch LN
Ashley, IL 62808-4108
Mailing address
13169 N Dutch LN
Ashley, IL 62808-4108
Phone (618) 485-6661
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 038005940 | Medicaid | IL | |
| 4182006 | Other | BLUE CROSS |
Other providers in Ashley, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.