MEDICARE: WILSON CHIROPRACTIC CENTER, PA

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	01-04137	KS

General Provider Information

NPI Number	:	1679531370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSON CHIROPRACTIC CENTER, PA

Provider Business Mailing Address
First Line	:	215 N VINE ST
Second Line	:
City	:	EL DORADO
State	:	KS
Zip	:	67042-2055
Country	:	US
Telephone Number	:	316-321-2273
Fax Number	:	316-321-2225

Provider Business Practice Location Address
First Line	:	215 N VINE ST
Second Line	:
City	:	EL DORADO
State	:	KS
Zip	:	67042-2055
Country	:	US
Telephone Number	:	316-321-2273
Fax Number	:	316-321-2225

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROSEMARIE A WILSON
Credential	:	DC
Telephone Number	:	316-321-2273

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	08/22/2020

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