Active NPI
Mike Scott Wasilisin, D.C.
- Rehabilitation Chiropractor
- San Diego, CA
National Provider Identifier
1194956102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Chiropractor
- License
- 31327
- Practice address
- 444 W C St
San Diego, CA 92101-3533 - Phone
- (619) 232-4030
- Fax
- (619) 232-4255
- NPI assigned
- Aug 7, 2009
- 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 |
|---|---|---|---|---|
| Rehabilitation Chiropractor | 111NR0400X | 31327 | CA | Primary |
Addresses
Primary practice location
444 W C St
San Diego, CA 92101-3533
Mailing address
6215 El Camino Real
Suite 100
Carlsbad, CA 92009-1604
Phone (760) 603-7900
Other names 1
- Mike Scott Wasilisin
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31327 | CA | MD | Rehabilitation Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Treatment and Health Mngmt | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Elite Performance Center
- Specialist
- San Diego, CA
- NPI 1851444145
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249603200000",
"number": "1194956102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6215 EL CAMINO REAL",
"address_2": "SUITE 100",
"city": "CARLSBAD",
"state": "CA",
"postal_code": "920091604",
"telephone_number": "760-603-7900",
"fax_number": "760-603-7997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "444 W C ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921013533",
"telephone_number": "619-232-4030",
"fax_number": "619-232-4255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASILISIN",
"first_name": "MIKE",
"middle_name": "SCOTT",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-08-07",
"last_updated": "2009-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "CA",
"license": "31327",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MIKE",
"last_name": "WASILISIN",
"middle_name": "SCOTT",
"credential": "D.C.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.