David Demetrius Wilson, DC, MS

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2019040226 Issued in MO

Practice address

338 SW Main St
Lees Summit, MO 64063-2340

Phone

(816) 600-5483

NPI assigned

Jun 23, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Chiropractic

Education

Cleveland Chiropractic College - Kansas City, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Sports and Family Chiropractic, LLCGroup PAC ID 7517036023, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

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.

• Advanced Sports and Family Chiropractic, LLC

  • Chiropractor
  • Overland Park, KS
  • NPI 1376710293

  MO

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1245856418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1627 SW MANOR LAKE DR",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640824183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "338 SW MAIN ST",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640632340",
            "telephone_number": "816-600-5483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DAVID",
        "middle_name": "DEMETRIUS",
        "credential": "DC, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-23",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2019040226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marnice J Willis, LCSW
• Wilshire Operator LLC
• Barry Scott Wilson, D.C.
• Crosby Wilson
• David Wilson, RPH
• Haley Nicole Wilson, PT, DPT
• Jonathan Edward Wilson, D.O.
• Kailey Wilson, DO
• Katherine Wilson, RBT
• Katherine Wilson

• Chiropractor in Lees Summit, MO
• Providers in Lees Summit, MO by specialty
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.