Annie Lee Mickelson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

14478 Issued in FL

Practice address

9033 Rocky Lake CT
Sarasota, FL 34238-4007

Phone

(612) 940-0827

NPI assigned

Dec 21, 2011

Last updated

Apr 10, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Annie Lee Wildberg Former name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2010

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lux Chiropractic LLC

  • Chiropractor
  • Sarasota, FL
  • NPI 1912750753
  NPD Authorized official
• Lifespan Chiropractic PA

  • Clinic/Center
  • Apple Valley, MN
  • NPI 1770864431
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1053680991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9033 ROCKY LAKE CT",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342384007",
            "telephone_number": "612-940-0827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9033 ROCKY LAKE CT",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342384007",
            "telephone_number": "612-940-0827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "ANNIE",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-21",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4726-12",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5549",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "14478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053680991",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNIE",
            "last_name": "WILDBERG",
            "middle_name": "LEE",
            "credential": "D.C.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Linda Michailidis, CRNA
• Madeline Noel Michaud, FNP-C
• Devlin Michel
• Lisa Marie Michel, D.C.
• Mickaella Moreta Corp
• Connie D Micklavzina, MD
• Scott A Middleton, DMD, MD
• Midnight Pass Chiropractic
• Midtown Diagnostic LLC (dba Midtown Radiology)
• Midtown Diagnostic LLC (dba Midtown Radiology)

• Chiropractor in Sarasota, FL
• Providers in Sarasota, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; 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.

Verify at the official NPI Registry.