Active NPI
Nicole Marie Wilson, D.C.
- Chiropractor
- Portland, OR
National Provider Identifier
1891929923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3914
- Practice address
- 1411 NW Raleigh Street
Portland, OR 97209-2573 - Phone
- (503) 803-2208
- NPI assigned
- May 4, 2009
- Sex
- Female
- 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 | 3914 | OR | Primary |
Addresses
Primary practice location
1411 NW Raleigh Street
Portland, OR 97209-2573
Mailing address
1411 NW Raleigh Street
Portland, OR 97209-2573
Phone (503) 803-2208
Other names 1
- Nicole Marie Stills
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 |
|---|---|---|---|
| 3914 | OR | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331856000000",
"number": "1891929923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1411 NW RALEIGH STREET",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972092573",
"telephone_number": "503-803-2208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1411 NW RALEIGH STREET",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972092573",
"telephone_number": "503-803-2208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "NICOLE",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-05-04",
"last_updated": "2012-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OR",
"license": "3914",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "NICOLE",
"last_name": "STILLS",
"middle_name": "MARIE",
"credential": "DC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.