Provider Demographics
NPI:1881698777
Name:WILSON, ROSEMARIE A (DC)
Entity type:Individual
Prefix:DR
First Name:ROSEMARIE
Middle Name:A
Last Name:WILSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N VINE ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2055
Mailing Address - Country:US
Mailing Address - Phone:316-321-2273
Mailing Address - Fax:316-321-2225
Practice Address - Street 1:215 N VINE ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2055
Practice Address - Country:US
Practice Address - Phone:316-321-2273
Practice Address - Fax:316-321-2225
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
KS01-04137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU36863Medicare UPIN
KS062187Medicare ID - Type Unspecified