NPIMap

Organization Active NPI

Healthsource of Coralville, PC

  • Chiropractor
  • Coralville, IA
National Provider Identifier
1376811471
Registry record updated Dec 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
06595 Issued in IA
Legal business name
HEALTHSOURCE OF CORALVILLE, PC
Practice address
18010 2ND Street
Suite 170
Coralville, IA 52241
Phone
(319) 373-7576
NPI assigned
Dec 5, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2011

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

Authorized official

Name
Dr. Jeffrey Wisdo, D.C.
Title
Owner
Phone
(319) 373-7576

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 06595 IA Primary

Addresses

Primary practice location

18010 2ND Street
Suite 170
Coralville, IA 52241

Mailing address

18010 2ND Street
Suite 170
Coralville, IA 52241
Phone (319) 373-7576

National Provider Directory

National Provider Directory

Locations

1801 2nd St
Ste 170
Coralville, IA 52241
Phone (319) 333-1268

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323043200000",
    "number": "1376811471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18010 2ND STREET",
            "address_2": "SUITE 170",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "52241",
            "telephone_number": "319-373-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18010 2ND STREET",
            "address_2": "SUITE 170",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "52241",
            "telephone_number": "319-373-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE OF CORALVILLE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-05",
        "last_updated": "2011-12-05",
        "status": "A",
        "authorized_official_last_name": "WISDO",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "319-373-7576",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "06595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coralville, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2011; 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.