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NPI Code Detail

MEDICARE: CLIFFORD WILSON D.C.

MEDICARE:   CLIFFORD  WILSON  D.C.
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
1111N00000XChiropractor5991MN

General Provider Information

NPI Number : 1750779252
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLIFFORD WILSON D.C.
Provider Business Mailing Address
First Line : 6466 KINGS DR
Second Line :
City : OAKDALE
State : MN
Zip : 55128-2523
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6466 KINGS DR
Second Line :
City : SAINT PAUL
State : MN
Zip : 55128-2523
Country : US
Telephone Number : 651-249-4181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2015
Last Update Date : 01/06/2015

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Directions to “ CLIFFORD WILSON D.C.” Practice Location

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