Individual provider Active NPI

Bryan Scott Wiebe, DC

  • Chiropractor
  • Seattle, WA
National Provider Identifier
1790826873
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH3113 Issued in WA
Practice address
4520 Fauntleroy Way SW
Seattle, WA 98126-2740
Phone
(206) 932-6605
Fax
(206) 933-6999
NPI assigned
Feb 9, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH3113 WA Primary

Addresses

Primary practice location

4520 Fauntleroy Way SW
Seattle, WA 98126-2740

Mailing address

4520 Fauntleroy Way SW
Seattle, WA 98126-2740
Phone (206) 932-6605

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110928000213 WA Practitioner - Chiropractic 3072784859 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4154 California Ave SW
Seattle, WA 98116-4102
Phone (206) 932-6605

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH3113WAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Fauntleroy Chiropractic, P.S. Chiropractor CurrentSince Oct 31, 2016 Accepting new patients

Locations

4154 California Ave SW
Seattle, WA 98116
Phone (206) 604-2584

4520 Fauntleroy Way SW
Seattle, WA 98126
Phone (206) 734-4981

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790826873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4520 FAUNTLEROY WAY SW",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981262740",
            "telephone_number": "206-932-6605",
            "fax_number": "206-933-6999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 FAUNTLEROY WAY SW",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981262740",
            "telephone_number": "206-932-6605",
            "fax_number": "206-933-6999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEBE",
        "first_name": "BRYAN",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH3113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

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.

Verify at the official NPI Registry.