Active NPI
Jack Wise, DC
- Chiropractor
- Fort Lauderdale, FL
National Provider Identifier
1780040808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH11489
- Practice address
- 701 E Broward Blvd Ste D
Fort Lauderdale, FL 33301-2022 - Phone
- (217) 494-3643
- NPI assigned
- Jan 5, 2016
- 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 | CH11489 | FL | Primary |
Addresses
Primary practice location
701 E Broward Blvd Ste D
Fort Lauderdale, FL 33301-2022
Mailing address
701 E Broward Blvd Ste D
Fort Lauderdale, FL 33301-2022
Phone (217) 494-3643
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 |
|---|---|---|---|
| CH11489 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451952000000",
"number": "1780040808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 E BROWARD BLVD STE D",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333012022",
"telephone_number": "217-494-3643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 E BROWARD BLVD STE D",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333012022",
"telephone_number": "217-494-3643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "JACK",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-01-05",
"last_updated": "2016-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH11489",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.