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General NPI Number Information
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NPI Number | 1831476134
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Entity Type | Individual
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Provider Name | MATTHEW BEN WILSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 902 W LUMSDEN RD SUITE 104
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City | BRANDON
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State | FL
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Zip | 33511-8806
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Country | US
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Telephone | 813-574-9206
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Fax | 813-654-9426
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Provider Business Mailing Address
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Address Line | 902 W LUMSDEN RD SUITE 104
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City | BRANDON
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State | FL
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Zip | 33511-8806
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Country | US
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Telephone | 813-574-9206
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Fax | 813-654-9426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 10346
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License Number State | FL
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