Provider Demographics
NPI:1194725283
Name:WILSON, CHRIS A (DC)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:A
Last Name:WILSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-2834
Mailing Address - Country:US
Mailing Address - Phone:620-221-4449
Mailing Address - Fax:620-221-4390
Practice Address - Street 1:805 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2834
Practice Address - Country:US
Practice Address - Phone:620-221-4449
Practice Address - Fax:620-221-4390
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4665111N00000X
OK3546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
060451OtherBLUE CROSS/BLUE SHIELD
350050266OtherRR MEDICARE
U81831Medicare UPIN
060451Medicare ID - Type Unspecified