MEDICARE: M WILSON LTD

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	1159	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861408023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M WILSON LTD

Provider Business Mailing Address
First Line	:	PO BOX 88
Second Line	:	619 NORTH MAIN
City	:	CAVE CITY
State	:	AR
Zip	:	72521-0088
Country	:	US
Telephone Number	:	870-283-5553
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 NORTH MAIN ST
Second Line	:
City	:	CAVE CITY
State	:	AR
Zip	:	72521-0088
Country	:	US
Telephone Number	:	870-283-5553
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL A WILSON
Credential	:	DC
Telephone Number	:	870-283-5553

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/03/2008

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