Provider Demographics
NPI:1174616999
Name:WILSON, STEVEN JOSEPH (BSC DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOSEPH
Last Name:WILSON
Suffix:
Gender:M
Credentials:BSC DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 WILMINGTON DR
Mailing Address - Street 2:STE. 120
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8773
Mailing Address - Country:US
Mailing Address - Phone:253-964-1325
Mailing Address - Fax:253-964-1329
Practice Address - Street 1:1570 WILMINGTON DR
Practice Address - Street 2:SUITE 120
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-8773
Practice Address - Country:US
Practice Address - Phone:253-964-1325
Practice Address - Fax:253-964-1329
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033638111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8801606OtherGROUP MEDICARE
WA2026177Medicaid
WA1366637233OtherGROUP NPI
WA8801606OtherGROUP MEDICARE
WA2026177Medicaid