Individual
JACOB WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
572 E CENTERTON BLVD, CENTERTON, AR 72719-6072
(479) 323-1010
Mailing address
572 E CENTERTON BLVD, CENTERTON, AR 72719-6072
(479) 323-1010
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
12405
AR
111N00000X
Chiropractor
14514
TX
Other
Enumeration date
10/19/2020
Last updated
09/24/2024
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