NPIMap

Organization Active NPI

Healthsource of North Liberty, PC

  • Chiropractor
  • North Liberty, IA
National Provider Identifier
1174890214
Registry record updated Nov 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
06595 Issued in IA
Legal business name
HEALTHSOURCE OF NORTH LIBERTY, PC
Practice address
215 Highway 965 NE
Suite 1
North Liberty, IA 52317-9091
Phone
(319) 373-7576
NPI assigned
Nov 17, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2011

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

Authorized official

Name
Dr. Jeffrey Wisdo, D.C.
Title
Owner
Phone
(319) 373-7576

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 06595 IA Primary

Addresses

Primary practice location

215 Highway 965 NE
Suite 1
North Liberty, IA 52317-9091

Mailing address

215 Highway 965 NE
Suite 1
North Liberty, IA 52317-9091
Phone (319) 373-7576

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1321488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321488000000",
    "number": "1174890214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 HIGHWAY 965 NE",
            "address_2": "SUITE 1",
            "city": "NORTH LIBERTY",
            "state": "IA",
            "postal_code": "523179091",
            "telephone_number": "319-373-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 HIGHWAY 965 NE",
            "address_2": "SUITE 1",
            "city": "NORTH LIBERTY",
            "state": "IA",
            "postal_code": "523179091",
            "telephone_number": "319-373-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE OF NORTH LIBERTY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-17",
        "last_updated": "2011-11-17",
        "status": "A",
        "authorized_official_last_name": "WISDO",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "319-373-7576",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "06595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Liberty, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; 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.