Organization Active NPI

Wilson Family Chiropractic Center Inc.

  • Chiropractor
  • Waterloo, IA
National Provider Identifier
1508819038
Registry record updated Jun 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
06870 Issued in IA
Legal business name
WILSON FAMILY CHIROPRACTIC CENTER INC.
Practice address
751 Progress Ave
Waterloo, IA 50701-3108
Phone
(319) 232-5366
Fax
(319) 232-5370
NPI assigned
May 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2012

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

Authorized official

Name
Dr. Zachary Paul Wilson, D.C.
Title
Doctor / Owner
Phone
(319) 232-5366

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 06870 IA Primary

Addresses

Primary practice location

751 Progress Ave
Waterloo, IA 50701-3108

Mailing address

751 Progress Ave
Waterloo, IA 50701-3108
Phone (319) 232-5366

Other identifiers 2

IdentifierTypeStateIssuer
0485664MedicaidIA
0485672MedicaidIA

National Provider Directory

National Provider Directory

Locations

751 Progress Ave
Waterloo, IA 50701
Phone (319) 232-5356

1911 Schukei Rd
Waterloo, IA 50702
Phone (319) 232-5356

Practitioners & affiliated clinicians

Practitioners 3

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": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339459200000",
    "number": "1508819038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 PROGRESS AVE",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507013108",
            "telephone_number": "319-232-5366",
            "fax_number": "319-232-5370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 PROGRESS AVE",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507013108",
            "telephone_number": "319-232-5366",
            "fax_number": "319-232-5370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON FAMILY CHIROPRACTIC CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2012-06-12",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "DOCTOR / OWNER",
        "authorized_official_telephone_number": "319-232-5366",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "06870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0485664",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0485672",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; 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.