Physician Compare National (NPI:1780607614)

HEALTHCARE PROVIDER:

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1780607614
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8527233428
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111205000244
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WILSON
	Individual professional last name
Provider First Name	RONALD
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CLEVELAND CHIROPRACTIC COLLEGE - KANSAS CITY
	Individual professional's medical school
Graduation Year	1989
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2003 E WABASH ST
	Group Practice or individual's line 1 address
Line 2 Street Address	CLINTON COUNTY CHIROPRACTIC CENTER
	Group Practice or individual's line 2 address
City	FRANKFORT
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	460412754
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7656544416
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y