Individual provider Active NPI

Lawrence Michael Wilner, DC

  • Massage Therapist
  • Shelton, CT
National Provider Identifier
1770632127
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
000862 Issued in CT
Practice address
3 Corporate Drive
Suite 160
Shelton, CT 06484
Phone
(203) 929-5500
Fax
(203) 926-1220
NPI assigned
Jan 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 000862 CT
Rehabilitation Chiropractor 111NR0400X 000862 CT
Massage Therapist 225700000X 000862 CT Primary

Addresses

Primary practice location

3 Corporate Drive
Suite 160
Shelton, CT 06484

Mailing address

3 Corporate Drive
Suite 160
Shelton, CT 06484
Phone (203) 929-5500

Other identifiers 2

IdentifierTypeStateIssuer
050000862CT01OtherCTANTHEM BCBS
CV2880OtherCTHEALTHNET LANDMARK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070828000378 CT Practitioner - Chiropractic 7416049010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
000862CTMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1770632127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 CORPORATE DRIVE",
            "address_2": "SUITE 160",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "06484",
            "telephone_number": "203-929-5500",
            "fax_number": "203-926-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 CORPORATE DRIVE",
            "address_2": "SUITE 160",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "06484",
            "telephone_number": "203-929-5500",
            "fax_number": "203-926-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILNER",
        "first_name": "LAWRENCE",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CT",
            "license": "000862",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "CT",
            "license": "000862",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CT",
            "license": "000862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "050000862CT01",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET LANDMARK",
            "identifier": "CV2880",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.