Wilderness Wellness Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

6436 Issued in MN

Legal business name

WILDERNESS WELLNESS CHIROPRACTIC LLC

Practice address

224 E Central Entrance Ste C
Duluth, MN 55811-5518

Phone

(218) 481-7330

Fax

(218) 481-7432

NPI assigned

Feb 1, 2018

Last updated

Feb 1, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kyle Severson, DCNPI 1942708235

Title

Chief Manager

Phone

(218) 481-7330

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

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.

• Kyle Severson, DC

  • Chiropractor
  • Duluth, MN
  • NPI 1942708235
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1517443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517443200000",
    "number": "1649778937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 E CENTRAL ENTRANCE STE C",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558115518",
            "telephone_number": "218-481-7330",
            "fax_number": "218-481-7432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 E CENTRAL ENTRANCE STE C",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558115518",
            "telephone_number": "218-481-7330",
            "fax_number": "218-481-7432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDERNESS WELLNESS CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-01",
        "last_updated": "2018-02-01",
        "status": "A",
        "authorized_official_last_name": "SEVERSON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "CHIEF MANAGER",
        "authorized_official_telephone_number": "218-481-7330",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "6436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica L Wilcken
• Aaron Joseph Wilcox, PT
• Jacob Avery Wilcox, MD
• Rachel Marie Wilcox, MD
• Kim L Wilde, MD
• Robert Earl Wildwood, LPN
• Sonja Wildwood, LPCC
• Elizabeth Jean Wilhelmson, P.T.
• Krista Wilhelmson, MD
• Kristine Marie Wilke, A.T.C-L

• Chiropractor in Duluth, MN
• Providers in Duluth, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.