Individual
MICHAEL A WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
619 NORTH MAIN STREET, CAVE CITY, AR 72521
(870) 283-5553
(870) 283-5133
Mailing address
PO BOX 88, CAVE CITY, AR 72521-0088
(870) 283-5553
(870) 283-5133
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1159
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16061000040
QUAL CHOICE
AR
01
—
59659
BLUE CROSS BLUE SHIELD
AR
Enumeration date
04/03/2007
Last updated
07/08/2007
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