Organization
ROBERT WILSON, DC, PLLC
Active
Other names
Life Source of Centerville
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT E WILSON DC (SOLE OWNER)
(931) 729-4001
Entity
Organization
Contact information
Practice address
132A N CENTRAL AVE, CENTERVILLE, TN 37033
(931) 729-4001
(931) 729-4081
Mailing address
PO BOX 99, CENTERVILLE, TN 37033-0099
(931) 729-4001
(931) 729-4081
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144589458
NPPES - INDIVIDUAL NPI
—
01
—
6128617
BLUE CROSS BLUE SHIED OF TENNESSEE
—
Enumeration date
12/07/2017
Last updated
06/11/2018
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