Provider Demographics
NPI:1366513475
Name:WILSON, SHEILA LANELL (DC)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:LANELL
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 1:5637 W 56TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1652
Mailing Address - Country:US
Mailing Address - Phone:317-297-8800
Mailing Address - Fax:317-297-9850
Practice Address - Street 1:5637 W 56TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1652
Practice Address - Country:US
Practice Address - Phone:317-297-8800
Practice Address - Fax:317-297-9850
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001636A111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200131080 AMedicaid
INU66212Medicare UPIN
IN200131080 AMedicaid