Nicole Hoyun Wan, DC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

15544 Issued in TX

Practice address

410 Pressler St
Austin, TX 78703-5100

Phone

(512) 770-6068

Fax

(512) 895-9896

NPI assigned

Dec 15, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: nicole.wan.1@29676.direct.athenahealth.com

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.

• Mitchell Schroeder LLC

  • Physical Therapy Clinic/Center
  • Boulder, CO
  • NPI 1164023768
  NPD (past)

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

{
    "created_epoch": "1639526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1487313607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "177 ARBORS CIR",
            "city": "ELGIN",
            "state": "TX",
            "postal_code": "786215636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 PRESSLER ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787035100",
            "telephone_number": "512-770-6068",
            "fax_number": "512-895-9896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAN",
        "first_name": "NICOLE",
        "middle_name": "HOYUN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-15",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "CHR.0008472",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "TX",
            "license": "15544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kallyopi Vafiadis Walton, APRN, CPNP-AC
• Mitchell Thomas Walton, MD
• Laura Sue Waltrip, MD
• Stephanie Lynn Walts-Osma, M.A., L.P.C.
• Jack Lee Walzel, MD
• Wanda E Price
• Gabriel D. Wander, CRNA
• Cheryl E. Wanek, P.T.
• Andrew Wang, D.O.
• Chiufen Wang, ACUPUNCTURIST

• Sports Physician Chiropractor in Austin, TX
• Providers in Austin, TX by specialty
• Sports Physician Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; 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.