Active NPI
Philip Edward Wulfert, DC
- Chiropractor
- Fredericktown, MO
National Provider Identifier
1780671545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CE 005627
- Practice address
- 207 S Main St
Fredericktown, MO 63645-1419 - Phone
- (573) 783-5530
- NPI assigned
- Oct 5, 2005
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CE 005627 | MO | Primary |
Addresses
Primary practice location
207 S Main St
Fredericktown, MO 63645-1419
Mailing address
207 S Main St
Fredericktown, MO 63645-1419
Phone (573) 783-5530
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 118699 | Other | MO | BLUE CROSS BLUE SHIELD |
| 133965 | Other | MO | HEALTHLINK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100823000299 | MO | Practitioner - Chiropractic | 0345374682 | Practice locations: Fredericktown, MO |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
207 S Main St
Fredericktown, MO 63645-1419
Phone (573) 783-5530
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CE 005627 | MO | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780671545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 S MAIN ST",
"city": "FREDERICKTOWN",
"state": "MO",
"postal_code": "636451419",
"telephone_number": "573-783-5530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 S MAIN ST",
"city": "FREDERICKTOWN",
"state": "MO",
"postal_code": "636451419",
"telephone_number": "573-783-5530"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WULFERT",
"first_name": "PHILIP",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MO",
"license": "CE 005627",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "118699",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "133965",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fredericktown, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.