Individual provider Active NPI

Jonathan Craig Wise, D.C.

  • Chiropractor
  • Mount Dora, FL
National Provider Identifier
1942446497
Registry record updated Dec 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
9678 Issued in FL
Practice address
17941 US Highway 441
Mount Dora, FL 32757-6717
Phone
(352) 516-6820
NPI assigned
Jan 5, 2009
Last updated
Dec 19, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 19, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 9678 FL Primary

Addresses

Primary practice location

17941 US Highway 441
Mount Dora, FL 32757-6717

Mailing address

17941 US Highway 441
Mount Dora, FL 32757-6717
Phone (352) 516-6820

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090319000122 FL Practitioner - Chiropractic 6103983143 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wise Chiropractic PAGroup PAC ID 1052579174, 2 clinicians

Practice addresses (Care Compare)

18130 US Hwy 441
Mount Dora, FL 32757-6720
Phone (352) 729-5105

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9678FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Wise Chiropractic PA Chiropractor CurrentSince Dec 8, 2011 Accepting new patients
Elite Chiropractic & Sports Rehab LLC Chiropractor Past Accepting new patients
Chiropractic USA of Buffalo Ridge Inc Chiropractor PastSince Aug 1, 2010 Accepting new patients
Keystone Chiropractic LLC Chiropractor PastSince Sep 21, 2025 Accepting new patients

Locations

17941 US Highway 441
Mount Dora, FL 32757
Phone (352) 516-6820

18130 US Highway 441
Mount Dora, FL 32757
Phone (352) 729-5105

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1231113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324252800000",
    "number": "1942446497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17941 US HIGHWAY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576717",
            "telephone_number": "352-516-6820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17941 US HIGHWAY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576717",
            "telephone_number": "352-516-6820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "JONATHAN",
        "middle_name": "CRAIG",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-01-05",
        "last_updated": "2011-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "9678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Dora, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; 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.