Jeffrey John Wisdo, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4705 Issued in MN

Practice address

7060 Valley Creek PLZ
#121
Woodbury, MN 55125-2269

Phone

(651) 735-8646

Fax

(651) 730-9210

NPI assigned

Jun 12, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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.

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  NPD (past)
• Shipman Chiropractic

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  • Davenport, IA
  • NPI 1710438445
  NPD (past)
• Shipman Chiropractic PC

  • Chiropractor
  • Davenport, IA
  • NPI 1538204425
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124060017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7060 VALLEY CREEK PLZ",
            "address_2": "#121",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252269",
            "telephone_number": "651-735-8646",
            "fax_number": "651-730-9210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7060 VALLEY CREEK PLZ",
            "address_2": "#121",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252269",
            "telephone_number": "651-735-8646",
            "fax_number": "651-730-9210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISDO",
        "first_name": "JEFFREY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "724T6WI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebekah Joy Wilson, PA
• Sheena Wilson
• Winston Behavioral Healthcare
• Teresa L Winston, MA
• Mallory Wirth
• Abby Witte
• David Martin Witte, D.C.
• Ashlyn Rae Woeltge
• Darii Wohlers, OTR/L
• Helen Z Wolday, RPH

• Chiropractor in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Chiropractor in Minnesota

• 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.