Koteuaisa Tanswanie Wilson, ch
Chiropractor in Lakeland, FL. Individual provider (NPI-1).
NPI number1295035558
StatusActive
Last updated in NPPESOct 5, 2022
Details
- NPI
- 1295035558
- Entity type
- Individual (NPI-1)
- Name
- Koteuaisa Tanswanie Wilson
- Credential
- ch
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Nov 2, 2010
- Certification date
- Oct 5, 2022
- Last updated
- Oct 5, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111N00000X | Chiropractor | CH10077 | FL | Yes |
Practice location
202 Lake Miriam Dr Ste W3Lakeland, FL 33813-2179
Phone 863-647-0808 · Fax 863-250-0715
Mailing address
202 Lake Miriam Dr Ste W3Lakeland, FL 33813-2179
Phone 863-647-0808 · Fax 863-250-0715
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