MEDICARE: ANN MARIE WILSON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4626	OK

General Provider Information

NPI Number	:	1205661576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE WILSON DC

Provider Business Mailing Address
First Line	:	4025 NW 61ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1417
Country	:	US
Telephone Number	:	405-651-1875
Fax Number	:

Provider Business Practice Location Address
First Line	:	6446 AVONDALE DR
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73116-6404
Country	:	US
Telephone Number	:	405-286-1259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2024
Last Update Date	:	09/05/2024

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Directions to “ ANN MARIE WILSON DC” Practice Location

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