Individual provider Active NPI

Jared Christopher Wisner, D.C.

  • Chiropractor
  • Overland Park, KS
National Provider Identifier
1265672802
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
01-05218 Issued in KS
Practice address
11775 W 112TH St Ste 103
Overland Park, KS 66210-2790
Phone
(913) 897-5485
NPI assigned
Feb 23, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 01-05218 KS Primary

Addresses

Primary practice location

11775 W 112TH St Ste 103
Overland Park, KS 66210-2790

Mailing address

11775 W 112TH St Ste 103
Overland Park, KS 66210-2790
Phone (913) 897-5485

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090430000495 KS Practitioner - Chiropractic 6709934797 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Cleveland Chiropractic College - Kansas City, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11775 W 112TH St
Suite 103
Overland Park, KS 66210-2790
Phone (913) 897-5485

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
01-05218KSMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Wisner Chiropractic, LLC Chiropractor CurrentSince Apr 6, 2009 Accepting new patients
Laser Chiropractic LLC Chiropractor PastSince Oct 27, 2019 Accepting new patients

Locations

11775 W 112th St
Ste 103
Overland Park, KS 66210
Phone (913) 897-5485

11720 W 135th St
Overland Park, KS 66221
Phone (913) 305-3686

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1235347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1265672802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11775 W 112TH ST STE 103",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662102790",
            "telephone_number": "913-897-5485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11775 W 112TH ST STE 103",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662102790",
            "telephone_number": "913-897-5485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISNER",
        "first_name": "JARED",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-23",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "KS",
            "license": "01-05218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2023; 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.