Amy Michelle Willcockson, D.C.

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

3845 Issued in MN

Practice address

1850 W Wayzata Blvd
Long Lake, MN 55356-9491

Phone

(952) 476-2260

Fax

(952) 476-4457

NPI assigned

Feb 28, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Align Health & Wellness PA

  • Rehabilitation Chiropractor
  • Long Lake, MN
  • NPI 1497175467
  NPD (past)

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942337696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 W WAYZATA BLVD",
            "address_2": "P.O. BOX 181",
            "city": "LONG LAKE",
            "state": "MN",
            "postal_code": "553569491",
            "telephone_number": "952-476-2260",
            "fax_number": "952-476-4457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 W WAYZATA BLVD",
            "city": "LONG LAKE",
            "state": "MN",
            "postal_code": "553569491",
            "telephone_number": "952-476-2260",
            "fax_number": "952-476-4457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLCOCKSON",
        "first_name": "AMY MICHELLE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "MN",
            "license": "3845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tonka Life Center, LTD
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• Angela Jean Weber, DCM
• West Lake Counseling and Wellness, Inc
• Wild Peace Integrative Wellness PLLC

• Rehabilitation Chiropractor in Long Lake, MN
• Providers in Long Lake, MN by specialty
• Rehabilitation Chiropractor in Minnesota

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.