Provider Demographics
NPI:1497078661
Name:WILSON, STIEHL C (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:STIEHL
Middle Name:C
Last Name:WILSON
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:ASH GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65604-0175
Mailing Address - Country:US
Mailing Address - Phone:417-323-1075
Mailing Address - Fax:417-323-1076
Practice Address - Street 1:600 E WELLS ST
Practice Address - Street 2:
Practice Address - City:ASH GROVE
Practice Address - State:MO
Practice Address - Zip Code:65604-9087
Practice Address - Country:US
Practice Address - Phone:417-323-1075
Practice Address - Fax:417-323-1076
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010001194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOK75000002Medicare PIN