Active NPI
Amanda Jean Wedlund, DC
- Chiropractor
- Pleasant Prairie, WI
National Provider Identifier
1063046787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5511-12
- Practice address
- 9755 76TH St Ste 730
Pleasant Prairie, WI 53158-1925 - Phone
- (262) 455-9440
- Fax
- (630) 468-1478
- NPI assigned
- Mar 3, 2020
- Last updated
- Jan 18, 2021
- Sex
- Female
- 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 | 5511-12 | WI | Primary |
Addresses
Primary practice location
9755 76TH St Ste 730
Pleasant Prairie, WI 53158-1925
Mailing address
2625 Butterfield Rd Ste 301N
Oak Brook, IL 60523-1266
Phone (630) 468-1824
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5511-12 | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610928000000",
"number": "1063046787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2625 BUTTERFIELD RD STE 301N",
"city": "OAK BROOK",
"state": "IL",
"postal_code": "605231266",
"telephone_number": "630-468-1824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9755 76TH ST STE 730",
"city": "PLEASANT PRAIRIE",
"state": "WI",
"postal_code": "531581925",
"telephone_number": "262-455-9440",
"fax_number": "630-468-1478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEDLUND",
"first_name": "AMANDA",
"middle_name": "JEAN",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-03",
"last_updated": "2021-01-18",
"certification_date": "2021-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "5511-12",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasant Prairie, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.