Individual
DR. ROGER W WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
200 PARK PL, CHAGRIN FALLS, OH 44022-4456
(440) 247-5383
(440) 338-1839
Mailing address
200 PARK PL, CHAGRIN FALLS, OH 44022-4456
(440) 247-5383
(440) 338-1839
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1341
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000149032
ANTHEM BC & BS
OH
01
—
1052235
AETNA
OH
01
—
421248625003
MEDICAL MUTUAL OF OH
OH
01
—
44-00336
UNITEDHEALTH CARE
OH
Enumeration date
11/08/2005
Last updated
07/08/2007
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