Individual
DR. NICOLE MARIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
1411 NW RALEIGH STREET, PORTLAND, OR 97209-2573
(503) 803-2208
Mailing address
1411 NW RALEIGH STREET, PORTLAND, OR 97209-2573
(503) 803-2208
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3914
OR
Other
Enumeration date
05/04/2009
Last updated
03/16/2012
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