Healthcare Provider Details

I. General information

NPI: 1780632711
Provider Name (Legal Business Name): MICHAEL CRAIG WILSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL CRAIG WILSON D.C.

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 W MAPLE ST
WICHITA KS
67213-2423
US

IV. Provider business mailing address

3161 W MAPLE ST
WICHITA KS
67213-2423
US

V. Phone/Fax

Practice location:
  • Phone: 316-942-9600
  • Fax: 316-351-6408
Mailing address:
  • Phone: 316-942-9600
  • Fax: 316-351-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104695
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104695
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: