Provider Demographics
NPI:1831476134
Name:WILSON, MATTHEW BEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BEN
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 1:902 W LUMSDEN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8806
Mailing Address - Country:US
Mailing Address - Phone:813-574-9206
Mailing Address - Fax:813-654-9426
Practice Address - Street 1:902 W LUMSDEN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8806
Practice Address - Country:US
Practice Address - Phone:813-574-9206
Practice Address - Fax:813-654-9426
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor