Provider Demographics
NPI:1588936801
Name:WILSON, TIMOTHY JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
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 1:4610 W MINERAL DR UNIT 1328
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-2582
Mailing Address - Country:US
Mailing Address - Phone:970-631-2844
Mailing Address - Fax:
Practice Address - Street 1:8357 N RAMPART RANGE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80125-9365
Practice Address - Country:US
Practice Address - Phone:303-932-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6774111N00000X
MO2011037863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor