Provider Demographics
NPI:1194088021
Name:WILSON, AARON J (DC)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:J
Last Name:WILSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S DUNLAP DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007
Mailing Address - Country:US
Mailing Address - Phone:719-547-2068
Mailing Address - Fax:719-547-2782
Practice Address - Street 1:356 S MCCULLOCH BLVD STE 106
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-2848
Practice Address - Country:US
Practice Address - Phone:719-647-2206
Practice Address - Fax:719-647-8866
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor