Individual provider Active NPI

Lisa J. Humfeld-Wilson, D.C.

  • Chiropractor
  • Faribault, MN
National Provider Identifier
1497742449
Registry record updated Dec 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4157 Issued in MN
Practice address
119 Central Ave N
Faribault, MN 55021-5210
Phone
(507) 333-5388
NPI assigned
Oct 4, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4157 MN Primary
Chiropractor 111N00000X 3817-012 WI

Addresses

Primary practice location

119 Central Ave N
Faribault, MN 55021-5210

Mailing address

119 Central Ave N
P.O. Box 893
Faribault, MN 55021-5210
Phone (507) 333-5388

Other identifiers 2

IdentifierTypeStateIssuer
080M0HUOtherMNBLUE CROSS BLUE SHIELD
872833000OtherMNMEDICAL ASSISTANCE

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

LicenseStateTypeSpecialty
3817-012WIMDChiropractor

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1497742449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 CENTRAL AVE N",
            "address_2": "P.O. BOX 893",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215210",
            "telephone_number": "507-333-5388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 CENTRAL AVE N",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215210",
            "telephone_number": "507-333-5388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMFELD-WILSON",
        "first_name": "LISA",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-04",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4157",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3817-012",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "080M0HU",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE",
            "identifier": "872833000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Faribault, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 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.