Doctor Name: | DR. MATTHEW BEN WILSON |
NPI Number: | 1831476134 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.C. |
License Number: | CH 10346 |
Business Practice Address: | 902 W Lumsden Rd Suite 104 Brandon, FL - 335118806 |
Business Phone Number: | 8135749206 |
Business Fax Number: | 8136549426 |
Mailing Address: | 902 W Lumsden Rd, Suite 104 BRANDON |
State: | FL |
Postal Code: | 335118806 |
Phone Number: | 8135749206 |
Fax Number: | 8136549426 |
NPI Enumeration Date: | 11/15/2011 |
NPI Last Update Date: | 03/25/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | CH 10346 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |