Kim L. Wist, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

X006556 Issued in NY

Practice address

125 Sunrise Hwy
West Islip, NY 11795-2009

Phone

(631) 422-0424

Fax

(631) 422-1076

NPI assigned

Mar 27, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kim L. Wist-Mangan Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Family Residences and Essential Enterprises, Inc.

  dba Terry's Place

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Old Bethpage, NY
  • NPI 1497943757
  NPD (past)

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114046893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 WAVERLY AVE",
            "city": "FARMINGVILLE",
            "state": "NY",
            "postal_code": "117381354",
            "telephone_number": "631-736-8439",
            "fax_number": "631-422-1076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 SUNRISE HWY",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117952009",
            "telephone_number": "631-422-0424",
            "fax_number": "631-422-1076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIST",
        "first_name": "KIM",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X006556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "WIST-MANGAN",
            "middle_name": "L.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jeffrey Lloyd Willig, M.D.
• Abralena De Jesus Wilson, D.O
• Cheyenne Wilson
• Daniel Mark Wilson Jr., RPA-C
• June Wisniewski
• Stephanie Wohlberg, MS, OTR/L
• Womack Primary Medical Care, PLLC (Womack Internal Medicine, PLLC)
• Lawrence H Womack, M.D.
• Matthew Leon Woolley, MD
• Stefani T Wren, MD

• Chiropractor in West Islip, NY
• Providers in West Islip, NY by specialty
• Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.