Provider Demographics
NPI:1306172630
Name:WILSON, DALE CURTIS (DC)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:CURTIS
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 1:21 E 58TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3711
Mailing Address - Country:US
Mailing Address - Phone:917-693-8050
Mailing Address - Fax:718-271-8117
Practice Address - Street 1:21 E 58TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3711
Practice Address - Country:US
Practice Address - Phone:917-693-8050
Practice Address - Fax:718-271-8117
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009379111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition