Active NPI
Jared Lane Wilson, DC
- Rehabilitation Chiropractor
- Spokane, WA
National Provider Identifier
1922350321
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Chiropractor
- License
- CH60542353
- Practice address
- 8611 N Division St Ste a
Spokane, WA 99208-5946 - Phone
- (509) 599-2766
- NPI assigned
- Oct 9, 2012
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | CH60542353 | WA | |
| Chiropractor | 111N00000X | CH60542353 | WA | |
| Rehabilitation Chiropractor | 111NR0400X | CH60542353 | WA | Primary |
Addresses
Primary practice location
8611 N Division St Ste a
Spokane, WA 99208-5946
Mailing address
3009 W Dalton Ave
Spokane, WA 99205-2220
Phone (509) 599-2766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150728005490 | WA | Practitioner - Chiropractic | 1254645765 | Practice locations: Spokane, WA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Western States College of Chiropractic, 2012
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
8611 N Division St a
Spokane, WA 99208-5946
Phone (509) 466-1366
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH60542353 | WA | MD | Rehabilitation Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732147200000",
"number": "1922350321",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3009 W DALTON AVE",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992052220",
"telephone_number": "509-599-2766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8611 N DIVISION ST STE A",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992085946",
"telephone_number": "509-599-2766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JARED",
"middle_name": "LANE",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-09",
"last_updated": "2024-11-21",
"certification_date": "2024-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "WA",
"license": "CH60542353",
"primary": false
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WA",
"license": "CH60542353",
"primary": false
},
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "WA",
"license": "CH60542353",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; 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.