Provider Demographics
NPI:1952106908
Name:WILSON, RYAN M (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:WILSON
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 STABLEGLEN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-0112
Mailing Address - Country:US
Mailing Address - Phone:214-598-2021
Mailing Address - Fax:
Practice Address - Street 1:345 W FARM TO MARKET 544 STE 300
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-6718
Practice Address - Country:US
Practice Address - Phone:972-578-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor