Active NPI
Michael Scott Wilson, D.C., QME
- Chiropractor
- Fairfield, CA
National Provider Identifier
1710095740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC25538
- Practice address
- 1252 Travis Blvd
Suite G
Fairfield, CA 94533-4886 - Phone
- (707) 426-1111
- Fax
- (707) 426-2725
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC25538 | CA | Primary |
Addresses
Primary practice location
1252 Travis Blvd
Suite G
Fairfield, CA 94533-4886
Mailing address
1252 Travis Blvd
Suite G
Fairfield, CA 94533-4886
Phone (707) 426-1111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Life Chiropractic College - West, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1252 Travis Blvd
Suite G
Fairfield, CA 94533-4840
Phone (707) 290-9639
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC25538 | CA | MD | Chiropractor |
| 25538 | CA | MD | Pharmacist |
Organizations & group practices 1
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.
-
- Chiropractor
- Fairfield, CA
- NPI 1760687271
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710095740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1252 TRAVIS BLVD",
"address_2": "SUITE G",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945334886",
"telephone_number": "707-426-1111",
"fax_number": "707-426-2725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1252 TRAVIS BLVD",
"address_2": "SUITE G",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945334886",
"telephone_number": "707-426-1111",
"fax_number": "707-426-2725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MICHAEL",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "D.C., QME",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC25538",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- 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.