MEDICARE: TREE OF LIFE SPINE

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	9922	TX

General Provider Information

NPI Number	:	1073728424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREE OF LIFE SPINE

Provider Business Mailing Address
First Line	:	309 S JUPITER RD STE 100
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-3052
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 S JUPITER RD STE 100
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-3052
Country	:	US
Telephone Number	:	214-547-7236
Fax Number	:

Authorized Official
Title or Position	:	DC
Name	:	DR. KEN WILSON
Credential	:
Telephone Number	:	214-547-7234

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	10/29/2007

Similar Medicare Providers

1902881865 — DR. KEN WILSON II D.C.
Practice Location Address:

309 S JUPITER RD , STE 100
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75002-3052

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1982155537 — ALLIED PHYSICAL MEDICINE, PA
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Directions to “TREE OF LIFE SPINE ” Practice Location

Language	Start Address	Practice Location

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