Individual
DR. JUDITH DIANE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
13169 N DUTCH LN, ASHLEY, IL 62808-4108
(618) 485-6661
(618) 485-6661
Mailing address
13169 N DUTCH LN, ASHLEY, IL 62808-4108
(618) 485-6661
(618) 485-6661
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038005940
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038005940
—
IL
01
—
4182006
BLUE CROSS
—
Enumeration date
11/17/2006
Last updated
06/03/2008
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