Provider Demographics
NPI:1316787286
Name:WILSON, CARLIE LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:CARLIE
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37381-4717
Mailing Address - Country:US
Mailing Address - Phone:423-326-9773
Mailing Address - Fax:
Practice Address - Street 1:150 LOVELL RD STE 107
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1900
Practice Address - Country:US
Practice Address - Phone:865-288-4568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor