MEDICARE: DR. STEPHEN LLOYD WILSON DC

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	4883	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	382161	OTHER	KY	ANTHEM
2	641489	OTHER	KY	AM CHI NETWORK
3	5795695	OTHER	KY	AETNA

General Provider Information

NPI Number	:	1144313842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN LLOYD WILSON DC

Provider Business Mailing Address
First Line	:	1412 N BROADWAY
Second Line	:	STE 206
City	:	LEXINGTON
State	:	KY
Zip	:	40505-3157
Country	:	US
Telephone Number	:	859-543-0252
Fax Number	:	859-543-0698

Provider Business Practice Location Address
First Line	:	1412 N BROADWAY
Second Line	:	STE 206
City	:	LEXINGTON
State	:	KY
Zip	:	40505-3157
Country	:	US
Telephone Number	:	859-543-0252
Fax Number	:	859-543-0698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/07/2010

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