Provider Demographics
NPI:1073612925
Name:WILSON, LYNN A (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNN
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 1:414 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1004
Mailing Address - Country:US
Mailing Address - Phone:785-448-6151
Mailing Address - Fax:785-448-6152
Practice Address - Street 1:414 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1004
Practice Address - Country:US
Practice Address - Phone:785-448-6151
Practice Address - Fax:785-448-6152
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS017554Medicare UPIN
KS023835Medicare ID - Type Unspecified