Organization
100YEARDOC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA M WILSON DC (CHIROPRACTOR)
(770) 422-9288
Entity
Organization
Contact information
Practice address
1135 S MARIETTA PKWY SE, MARIETTA, GA 30060-2830
(770) 422-9288
Mailing address
1135 S MARIETTA PKWY SE, MARIETTA, GA 30060-2811
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
10/18/2018
Last updated
10/22/2018
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