NPIMap

Organization Active NPI

Wilson Chiropractic

  • Chiropractor
  • Beaumont, TX
National Provider Identifier
1740493840
Registry record updated Dec 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
WILSON CHIROPRACTIC
Practice address
7060 Phelan Blvd
Suite 101
Beaumont, TX 77706-6168
Phone
(409) 866-8661
Fax
(409) 866-4371
NPI assigned
May 7, 2007
Last updated
Dec 19, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2007

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

Authorized official

Name
Dr. Robert David Wilson, DC
Title
Owner
Phone
(409) 866-8661

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

7060 Phelan Blvd
Suite 101
Beaumont, TX 77706-6168

Mailing address

7060 Phelan Blvd
Suite 101
Beaumont, TX 77706-6168
Phone (409) 866-8661

Other identifiers 1

IdentifierTypeStateIssuer
0052KVOtherTXBLUE CROSS GROUP ID

National Provider Directory

National Provider Directory

Locations

7060 Phelan Blvd
Ste 101
Beaumont, TX 77706
Phone (409) 866-8661

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198022400000",
    "number": "1740493840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7060 PHELAN BLVD",
            "address_2": "SUITE 101",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777066168",
            "telephone_number": "409-866-8661",
            "fax_number": "409-866-4371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7060 PHELAN BLVD",
            "address_2": "SUITE 101",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777066168",
            "telephone_number": "409-866-8661",
            "fax_number": "409-866-4371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2007-12-19",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "409-866-8661",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP ID",
            "identifier": "0052KV",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; 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.