Thomas Charles Wilson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

001629 Issued in MN

Practice address

213 State St W
Detroit Lakes, MN 56501-3005

Phone

(218) 847-4366

Fax

(218) 847-1838

NPI assigned

Apr 20, 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 3

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Detroit Lakes Chiropractic, PCGroup PAC ID 3072846195, 2 clinicians

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.

• Detroit Lakes Chiropractic, PC

  • Chiropractor
  • Detroit Lakes, MN
  • NPI 1235793886
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267142400000",
    "number": "1679538565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 STATE ST W",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013005",
            "telephone_number": "218-847-4366",
            "fax_number": "218-847-1838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 STATE ST W",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013005",
            "telephone_number": "218-847-4366",
            "fax_number": "218-847-1838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "THOMAS",
        "middle_name": "CHARLES",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2010-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "001629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "49403WI",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "972327700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC CARE OF MN",
            "identifier": "410144",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robin Leslie Wicker, MSW, LICSW, RPT-S
• Anna Wientjes
• Kelsey Wilberg, PT
• Megan Wilke
• Robert John Williams, MA, LADC, LPC, LAC
• Greta Winter, LADC
• Kisuk Bae Wirtz
• Claire Wolhowe
• Caitlyn Ann Wolter, OTR/L
• Terry Jo Wood, LADC

• Chiropractor in Detroit Lakes, MN
• Providers in Detroit Lakes, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2010; 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.