Provider Demographics
NPI:1588656086
Name:WILSON, ARVIN R (DC)
Entity Type:Individual
Prefix:DR
First Name:ARVIN
Middle Name:R
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 1:559 EDGEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2358
Mailing Address - Country:US
Mailing Address - Phone:406-862-8080
Mailing Address - Fax:406-862-2769
Practice Address - Street 1:559 EDGEWOOD PL
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2358
Practice Address - Country:US
Practice Address - Phone:406-862-8080
Practice Address - Fax:406-862-2769
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT161070Medicaid
4107Medicare ID - Type Unspecified
MT161070Medicaid