Active NPI
Ron Clyde Wilson, D.C.
- Chiropractor
- Mesa, AZ
National Provider Identifier
1003954645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 4036
- Practice address
- 3654 N Power Rd Ste 143
Mesa, AZ 85215 - Phone
- (480) 396-8665
- NPI assigned
- Feb 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4036 | AZ | Primary |
Addresses
Primary practice location
3654 N Power Rd Ste 143
Mesa, AZ 85215
Mailing address
3654 N Power Rd Ste 143
Mesa, AZ 85215-9793
Phone (480) 396-8665
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051116000096 | AZ | Practitioner - Chiropractic | 9234158502 | Practice locations: Mesa, AZ |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- National College of Chiropractic, 1978
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
3654 N Power Rd
Mesa, AZ 85215-9793
Phone (480) 396-8665
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531267200000",
"number": "1003954645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3654 N POWER RD STE 143",
"city": "MESA",
"state": "AZ",
"postal_code": "852159793",
"telephone_number": "480-396-8665",
"fax_number": "480-396-6324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3654 N POWER RD STE 143",
"city": "MESA",
"state": "AZ",
"postal_code": "85215",
"telephone_number": "480-396-8665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "RON",
"middle_name": "CLYDE",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-04",
"last_updated": "2018-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "AZ",
"license": "4036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.