Active NPI
Wilson Jordan
- Massage Therapist
- Issaquah, Wa, WA
National Provider Identifier
1710437835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA00004192
- Practice address
- 1836 25TH Ave NE
Issaquah Highlands Chiropractic, Laser, & Massage Thera
Issaquah, Wa, WA 98029 - Phone
- (425) 427-0809
- NPI assigned
- Oct 12, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA00004192 | WA | Primary |
Addresses
Primary practice location
1836 25TH Ave NE
Issaquah Highlands Chiropractic, Laser, & Massage Thera
Issaquah, Wa, WA 98029
Mailing address
1836 25TH Ave NE
Issaquah Highlands Chiropractic, Laser, & Massage Thera
Issaquah, Wa, WA 98029
Phone (425) 427-0809
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00004192 | WA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upton Chiropractic | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Chiropractor
- Issaquah, WA
- NPI 1669779419
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477526400000",
"number": "1710437835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1836 25TH AVE NE",
"address_2": "ISSAQUAH HIGHLANDS CHIROPRACTIC, LASER, & MASSAGE THERA",
"city": "ISSAQUAH, WA",
"state": "WA",
"postal_code": "98029",
"telephone_number": "425-427-0809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1836 25TH AVE NE",
"address_2": "ISSAQUAH HIGHLANDS CHIROPRACTIC, LASER, & MASSAGE THERA",
"city": "ISSAQUAH, WA",
"state": "WA",
"postal_code": "98029",
"telephone_number": "425-427-0809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "WILSON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-10-12",
"last_updated": "2016-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA00004192",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.