Healthcare Provider Details

I. General information

NPI: 1952106908
Provider Name (Legal Business Name): RYAN M WILSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W FARM TO MARKET 544 STE 300
MURPHY TX
75094-6718
US

IV. Provider business mailing address

16582 MELLEN LN
JUPITER FL
33478-6004
US

V. Phone/Fax

Practice location:
  • Phone: 972-578-2225
  • Fax:
Mailing address:
  • Phone: 214-598-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16318
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: