Individual
JOSEPH WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
755 S TELSHOR BLVD STE 102, LAS CRUCES, NM 88011-4688
(575) 532-1116
(575) 532-7050
Mailing address
880 S TELSHOR BLVD, STE 220, LAS CRUCES, NM 88011-8682
(575) 649-4964
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
853
NM
111NR0400X
Rehabilitation Chiropractor
4937
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5677101
AETNA
TX
01
—
603805
BCBS OF TEXAS
TX
Enumeration date
01/16/2007
Last updated
08/11/2020
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