Provider Demographics
NPI:1437450467
Name:WILSON, BARRY SCOTT (DC)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:SCOTT
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 1:13313 PRATT RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-9422
Mailing Address - Country:US
Mailing Address - Phone:816-537-8133
Mailing Address - Fax:
Practice Address - Street 1:13313 PRATT RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-9422
Practice Address - Country:US
Practice Address - Phone:816-537-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor