Active NPI
David Wickes, D.C.
- Internist Chiropractor
- Shelton, CT
National Provider Identifier
1811289085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internist Chiropractor
- License
- 038003761
- Practice address
- 453 Fisher CT
Shelton, CT 06484-2836 - Phone
- (503) 341-2570
- NPI assigned
- May 6, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internist Chiropractor | 111NI0900X | CH00034818 | WA | |
| Internist Chiropractor | 111NI0900X | 038003761 | IL | Primary |
Addresses
Primary practice location
453 Fisher CT
Shelton, CT 06484-2836
Mailing address
453 Fisher CT
Shelton, CT 06484-2836
Phone (503) 341-2570
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 |
|---|---|---|---|
| 038003761 | IL | MD | Internist Chiropractor |
| CH00034818 | WA | MD | Internist Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379462400000",
"number": "1811289085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "453 FISHER CT",
"city": "SHELTON",
"state": "CT",
"postal_code": "064842836",
"telephone_number": "503-341-2570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "453 FISHER CT",
"city": "SHELTON",
"state": "CT",
"postal_code": "064842836",
"telephone_number": "503-341-2570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKES",
"first_name": "DAVID",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-05-06",
"last_updated": "2013-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "111NI0900X",
"taxonomy_group": "",
"desc": "Chiropractor, Internist",
"state": "WA",
"license": "CH00034818",
"primary": false
},
{
"code": "111NI0900X",
"taxonomy_group": "",
"desc": "Chiropractor, Internist",
"state": "IL",
"license": "038003761",
"primary": true
}
],
"identifiers": [],
"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 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.