Individual
JASON ANDREW WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.AC. M.S.O.M.
Contact information
Practice address
14785 W 101ST AVE # 101, DYER, IN 46311-3371
(219) 689-5563
(219) 979-5253
Mailing address
14785 W 101ST AVE # 101, DYER, IN 46311-3371
(219) 689-5563
(219) 979-5253
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
198.000780
IL
Other
Enumeration date
06/05/2008
Last updated
11/18/2021
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