Active NPI
Kenneth L. Wiltbank, D.C.
- Chiropractor
- Snowflake, AZ
National Provider Identifier
1285694638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5093
- Practice address
- 229 S Main St
Snowflake, AZ 85937-5316 - Phone
- (928) 536-3235
- NPI assigned
- Mar 27, 2006
- Last updated
- Jan 26, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5093 | AZ | Primary |
Addresses
Primary practice location
229 S Main St
Snowflake, AZ 85937-5316
Mailing address
PO Box 982
Snowflake, AZ 85937-0982
Phone (928) 536-3235
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0239680 | Other | AZ | BLUE CROSS BLUE SHIELD |
| 350050540 | Medicaid | AZ | |
| 5093 | Other | AZ | LICENCE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051026000521 | AZ | Practitioner - Chiropractic | 2466479746 | Practice locations: Snowflake, AZ |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Cleveland Chiropractic College - Kansas City, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
229 S Main St
Snowflake, AZ 85937-5316
Phone (928) 536-3235
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5093 | AZ | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485388800000",
"number": "1285694638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 982",
"city": "SNOWFLAKE",
"state": "AZ",
"postal_code": "859370982",
"telephone_number": "928-536-3235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "229 S MAIN ST",
"city": "SNOWFLAKE",
"state": "AZ",
"postal_code": "859375316",
"telephone_number": "928-536-3235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILTBANK",
"first_name": "KENNETH",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-27",
"last_updated": "2017-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "AZ",
"license": "5093",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0239680",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "350050540",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENCE NUMBER",
"identifier": "5093",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Snowflake, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; 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.