Individual
DR. KEN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
3238 171ST AVE NE, HAM LAKE, MN 55304-5115
(612) 802-3646
Mailing address
3238 171ST AVE NE, HAM LAKE, MN 55304-5115
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6350
MN
Other
Enumeration date
07/31/2019
Last updated
07/31/2019
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