Provider Demographics
NPI:1093083271
Name:WILSON, SETH M (DC)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:M
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 1:4556 QUINCE RD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:MO
Mailing Address - Zip Code:64865-8037
Mailing Address - Country:US
Mailing Address - Phone:417-776-4556
Mailing Address - Fax:
Practice Address - Street 1:4556 QUINCE RD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:MO
Practice Address - Zip Code:64865
Practice Address - Country:US
Practice Address - Phone:417-776-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15924111N00000X, 171100000X
MO2011013813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1801872304OtherGROUP NPI
AR15924OtherLICENSE
MO2011013813OtherLICENSE
AR1801872304OtherGROUP NPI