MEDICARE: DR. MICHAEL C. WILSON D.C.

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	03286	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811974074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C. WILSON D.C.

Provider Business Mailing Address
First Line	:	15728 LORAIN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5542
Country	:	US
Telephone Number	:	440-777-6017
Fax Number	:	440-777-6940

Provider Business Practice Location Address
First Line	:	15728 LORAIN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5542
Country	:	US
Telephone Number	:	216-252-6224
Fax Number	:	216-252-6234

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	09/25/2008

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