Active NPI
Matthew C Wilson
- Chiropractor
- Fargo, ND
National Provider Identifier
1376192237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1110
- Practice address
- 3175 Sienna Dr S Ste 105
Fargo, ND 58104-8910 - Phone
- (701) 451-9098
- Fax
- (701) 451-9099
- NPI assigned
- Sep 4, 2019
- Sex
- Male
- Sole proprietor
- No
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 | 1110 | ND | Primary |
Addresses
Primary practice location
3175 Sienna Dr S Ste 105
Fargo, ND 58104-8910
Mailing address
3175 Sienna Dr S Ste 105
Fargo, ND 58104-8910
Phone (701) 451-9098
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1110 | ND | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567555200000",
"number": "1376192237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3175 SIENNA DR S STE 105",
"city": "FARGO",
"state": "ND",
"postal_code": "581048910",
"telephone_number": "701-451-9098",
"fax_number": "701-451-9099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3175 SIENNA DR S STE 105",
"city": "FARGO",
"state": "ND",
"postal_code": "581048910",
"telephone_number": "701-451-9098",
"fax_number": "701-451-9099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MATTHEW",
"middle_name": "C",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-04",
"last_updated": "2019-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "ND",
"license": "1110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.