Wake Forest Chiropractic, PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2222 Issued in NC

Legal business name

WAKE FOREST CHIROPRACTIC, PA

Practice address

851 Wake Forest Business Park
Ste E
Wake Forest, NC 27587-7366

Phone

(919) 562-0302

Fax

(919) 569-9560

NPI assigned

Nov 9, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Shawn P Phelan, D.O.

Title

Owner

Phone

(919) 562-0302

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• WAKE FOREST CHIROPRACTIC, PA Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Evan Jonathon Wagoner, DC

  • Chiropractor
  • Wake Forest, NC
  • NPI 1710507488
  NPD

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571875200000",
    "number": "1720158199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 WAKE FOREST BUSINESS PARK",
            "address_2": "STE E",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275877366",
            "telephone_number": "919-562-0302",
            "fax_number": "919-569-9560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 WAKE FOREST BUSINESS PARK",
            "address_2": "STE E",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275877366",
            "telephone_number": "919-562-0302",
            "fax_number": "919-569-9560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST CHIROPRACTIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2019-10-24",
        "status": "A",
        "authorized_official_last_name": "PHELAN",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-562-0302",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "2222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTHCARE",
            "identifier": "2107045",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC NETWORK",
            "identifier": "08871",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN CHIROPRACTIC NET",
            "identifier": "613467",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8908871",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WAKE FOREST CHIROPRACTIC, PA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WAKE FOREST CHIROPRACTIC, PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wake Family Chiropractic PA
• Wake Foot and Ankle Center PLLC
• Wake Forest Adult Day Care Inc
• Wake Forest Adult Day Health Inc.
• Wake Forest Adult Health Inc
• Wake Forest Counseling Services, Inc.
• Wake Forest Drug Inc
• Wake Forest Family Eye Care, O.D., P.a.
• Wake Forest Internal Medicine and Primary Care
• Wake Forest Optometry PA

• Chiropractor in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.