Active NPI
Koteuaisa Tanswanie Wilson, CH
- Chiropractor
- Lakeland, FL
National Provider Identifier
1295035558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH10077
- Practice address
- 202 Lake Miriam Dr Ste W3
Lakeland, FL 33813-2179 - Phone
- (863) 647-0808
- Fax
- (863) 250-0715
- NPI assigned
- Nov 2, 2010
- Sex
- Female
- 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 | CH10077 | FL | Primary |
Addresses
Primary practice location
202 Lake Miriam Dr Ste W3
Lakeland, FL 33813-2179
Mailing address
202 Lake Miriam Dr Ste W3
Lakeland, FL 33813-2179
Phone (863) 647-0808
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CH10077 | Other | FL | FL MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Networks
- Freedom Health HMO Network
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.
-
- Chiropractor
- Lakeland, FL
- NPI 1609241884
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664928000000",
"number": "1295035558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 LAKE MIRIAM DR STE W3",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338132179",
"telephone_number": "863-647-0808",
"fax_number": "863-250-0715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 LAKE MIRIAM DR STE W3",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338132179",
"telephone_number": "863-647-0808",
"fax_number": "863-250-0715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KOTEUAISA",
"middle_name": "TANSWANIE",
"credential": "CH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-11-02",
"last_updated": "2022-10-05",
"certification_date": "2022-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH10077",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FL MEDICAL LICENSE",
"identifier": "CH10077",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.