Active NPI
Laurent Edward Wanner, D.C.
- Occupational Health Chiropractor
- Crescent City, CA
National Provider Identifier
1093892697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Health Chiropractor
- License
- DC0020025
- Practice address
- 1000 Northcrest Dr Ste 3
Crescent City, CA 95531-2317 - Phone
- (707) 465-4132
- Fax
- (707) 465-4132
- NPI assigned
- Nov 1, 2006
- Last updated
- Sep 16, 2016
- 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 |
|---|---|---|---|---|
| Occupational Health Chiropractor | 111NX0100X | DC0020025 | CA | Primary |
Addresses
Primary practice location
1000 Northcrest Dr Ste 3
Crescent City, CA 95531-2317
Mailing address
1000 Northcrest Dr Ste 3
Crescent City, CA 95531-2317
Phone (707) 465-4132
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DC0200250 | Medicaid | CA |
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 |
|---|---|---|---|
| DC0020025 | CA | MD | Occupational Health Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Hospice Inc | Past | Accepting new patients |
Organizations & group practices 5
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.
-
- Chiropractor
- Crescent City, CA
- NPI 1639620685
-
dba Wanner Sports & Family Chiropractic
- Chiropractor
- Crescent City, CA
- NPI 1649721523
-
dba Wanner Sports & Family Chiropractic
- Health Service Clinic/Center
- Crescent City, CA
- NPI 1720387228
-
- Preferred Provider Organization
- Crescent City, CA
- NPI 1457759920
-
- Community Based Hospice Care Agency
- Crescent City, CA
- NPI 1407459308
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473984000000",
"number": "1093892697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 NORTHCREST DR STE 3",
"city": "CRESCENT CITY",
"state": "CA",
"postal_code": "955312317",
"telephone_number": "707-465-4132",
"fax_number": "707-465-4132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 NORTHCREST DR STE 3",
"city": "CRESCENT CITY",
"state": "CA",
"postal_code": "955312317",
"telephone_number": "707-465-4132",
"fax_number": "707-465-4132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANNER",
"first_name": "LAURENT",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2016-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "111NX0100X",
"taxonomy_group": "",
"desc": "Chiropractor, Occupational Health",
"state": "CA",
"license": "DC0020025",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DC0200250",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Crescent City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.