Wilson C Park Chiropractic Corp

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC25166 Issued in CA

Legal business name

WILSON C PARK CHIROPRACTIC CORP

Practice address

2940 Westwood Blvd
#1
Los Angeles, CA 90064-4145

Phone

(310) 869-0536

Fax

(310) 441-3727

NPI assigned

Jun 26, 2008

Organization subpart

No

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

Authorized official

Name

Wilson Park, DCNPI 1548337587

Title

Chiropractor

Phone

(310) 869-0536

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

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

• Wilson C Park, D.C.

  • Chiropractor
  • Los Angeles, CA
  • NPI 1548337587
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1427210822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 WESTWOOD BLVD",
            "address_2": "#1",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90064",
            "telephone_number": "310-869-0536",
            "fax_number": "310-441-3727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 WESTWOOD BLVD",
            "address_2": "#1",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900644145",
            "telephone_number": "310-869-0536",
            "fax_number": "310-441-3727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON C PARK CHIROPRACTIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-26",
        "last_updated": "2008-06-26",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "WILSON",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "310-869-0536",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC25166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "DC251660",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wilshire Wellness Center
• Wilshire Wellness, Inc
• Wilshire West Dental GRP.
• Wilshire Westgate Dental, Inc.
• Wilshire Westgate Pharmacy
• Wilson H Park, M.D.,Inc.
• Ashley Lynn Wilson-Dixon, MSW, ASW, PPSC
• Angelia Lynetta Wilson-Robinson, RN
• Abigail Leigh Wilson
• Agia Wilson

• Chiropractor in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; 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.

Verify at the official NPI Registry.