MEDICARE: DR. KEN WILSON II 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
1	111N00000X	Chiropractor	9922	TX

General Provider Information

NPI Number	:	1902881865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEN WILSON II D.C.

Provider Business Mailing Address
First Line	:	309 S JUPITER RD
Second Line	:	STE 100
City	:	ALLEN
State	:	TX
Zip	:	75002-3052
Country	:	US
Telephone Number	:	214-547-7234
Fax Number	:	214-547-7236

Provider Business Practice Location Address
First Line	:	309 S JUPITER RD
Second Line	:	STE 100
City	:	ALLEN
State	:	TX
Zip	:	75002-3052
Country	:	US
Telephone Number	:	214-547-7234
Fax Number	:	214-547-7236

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	06/26/2008

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