Provider Demographics
NPI:1457595043
Name:WILSON, MATTHEW ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ANDREW
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 1:403 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MADRID
Mailing Address - State:IA
Mailing Address - Zip Code:50156-1145
Mailing Address - Country:US
Mailing Address - Phone:515-423-2084
Mailing Address - Fax:
Practice Address - Street 1:5504 ASHWORTH RD
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7100
Practice Address - Country:US
Practice Address - Phone:515-225-4002
Practice Address - Fax:888-550-7916
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor