NPIMap

Organization Active NPI

Wildenauer Chiropractic Clinic LTD

  • Chiropractor
  • Saint Paul, MN
National Provider Identifier
1306061155
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1475 Issued in MN
Legal business name
WILDENAUER CHIROPRACTIC CLINIC LTD
Practice address
1525 Livingston Ave
Saint Paul, MN 55118-3430
Phone
(651) 455-5264
Fax
(651) 455-1172
NPI assigned
Apr 16, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jerrold Richard Wildenauer, DCNPI 1720091051
Title
Owner
Phone
(651) 455-5264

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1475 MN Primary

Addresses

Primary practice location

1525 Livingston Ave
Saint Paul, MN 55118-3430

Mailing address

1525 Livingston Ave
Saint Paul, MN 55118-3430
Phone (651) 455-5264

National Provider Directory

National Provider Directory

Locations

1525 Livingston Ave
West St Paul, MN 55118
Phone (651) 455-5264

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306061155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 LIVINGSTON AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551183430",
            "telephone_number": "651-455-5264",
            "fax_number": "651-455-1172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 LIVINGSTON AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551183430",
            "telephone_number": "651-455-5264",
            "fax_number": "651-455-1172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDENAUER CHIROPRACTIC CLINIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILDENAUER",
        "authorized_official_first_name": "JERROLD",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-455-5264",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "1475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.