Wilson C Park, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC25166 Issued in CA

Practice address

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

Phone

(310) 869-0536

Fax

(310) 441-3727

NPI assigned

Nov 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Chiropractic

Education

Cleveland Chiropractic College - Los Angeles, 1997

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Wilson C Park Chiropractic Corp

  • Chiropractor
  • Los Angeles, CA
  • NPI 1427210822
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548337587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 WESTWOOD BLVD",
            "address_2": "SUITE #1",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900644145",
            "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": "SUITE #1",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900644145",
            "telephone_number": "310-869-0536",
            "fax_number": "310-441-3727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "WILSON",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC25166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "DC251660",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tae Sook Park, ACUPUNCTURIST
• Taino Park, DDS
• Taryn Kiani Michiko Park
• Wanchoe Park, LCSW
• Wendy Ann Park, LCSW. MBA
• Wilson Ho Park, MD
• Won Bo Park, DDS
• Wonju Park, NP
• Woo Sung Park, D.D.S., M.D.S.
• Yeongju Park, L,AC

• 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.