Individual provider Active NPI

Michelle L Wesely, DC

  • Chiropractor
  • Glen Ellyn, IL
National Provider Identifier
1699744078
Registry record updated Mar 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038009494 Issued in IL
Practice address
800 Roosevelt Rd
BLDG B 112
Glen Ellyn, IL 60137-5839
Phone
(630) 790-3335
Fax
(630) 790-3345
NPI assigned
Mar 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038009494 IL Primary

Addresses

Primary practice location

800 Roosevelt Rd
BLDG B 112
Glen Ellyn, IL 60137-5839

Mailing address

800 Roosevelt Rd
BLDG B 112
Glen Ellyn, IL 60137-5908
Phone (630) 790-3335

Other identifiers 1

IdentifierTypeStateIssuer
02232331OtherILBCBSIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040320000242 IL Practitioner - Chiropractic 6901797042

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038009494ILMDChiropractor

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364342400000",
    "number": "1699744078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 ROOSEVELT RD",
            "address_2": "BLDG B 112",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375908",
            "telephone_number": "630-790-3335",
            "fax_number": "630-790-3345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ROOSEVELT RD",
            "address_2": "BLDG B 112",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375839",
            "telephone_number": "630-790-3335",
            "fax_number": "630-790-3345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESELY",
        "first_name": "MICHELLE",
        "middle_name": "L",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-16",
        "last_updated": "2013-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038009494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL",
            "identifier": "02232331",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Ellyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2013; 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.