Organization Active NPI

Nobles Chiropractic Wellness Center, LLC

  • Chiropractor
  • Lakewood, WI
National Provider Identifier
1629000120
Registry record updated Oct 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3964-012 Issued in WI
Legal business name
NOBLES CHIROPRACTIC WELLNESS CENTER, LLC
Practice address
15481 Commercial Rd
Lakewood, WI 54138-9677
Phone
(715) 276-3401
Fax
(715) 276-1533
NPI assigned
Jul 7, 2006
Last updated
Oct 20, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2010

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

Authorized official

Name
Dr. Jason W. Nobles, DC
Title
Owner
Phone
(715) 276-3401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3964-012 WI Primary

Addresses

Primary practice location

15481 Commercial Rd
Lakewood, WI 54138-9677

Mailing address

15481 Commercial Rd
Lakewood, WI 54138-9677
Phone (715) 276-3401

Other identifiers 1

IdentifierTypeStateIssuer
39002300MedicaidWI

National Provider Directory

National Provider Directory

Locations

15481 Commercial Rd
Lakewood, WI 54138
Phone (715) 276-3401

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287532800000",
    "number": "1629000120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15481 COMMERCIAL RD",
            "city": "LAKEWOOD",
            "state": "WI",
            "postal_code": "541389677",
            "telephone_number": "715-276-3401",
            "fax_number": "715-276-1533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15481 COMMERCIAL RD",
            "city": "LAKEWOOD",
            "state": "WI",
            "postal_code": "541389677",
            "telephone_number": "715-276-3401",
            "fax_number": "715-276-1533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOBLES CHIROPRACTIC WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2010-10-20",
        "status": "A",
        "authorized_official_last_name": "NOBLES",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-276-3401",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3964-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39002300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; 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.