Active NPI
Kyle Richard Ikaika Wilson, DC
- Chiropractor
- Vancouver, WA
National Provider Identifier
1942898358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 61129517
- Practice address
- 4001 Main St Ste 200
Vancouver, WA 98663-1894 - Phone
- (360) 693-3030
- NPI assigned
- Jan 2, 2021
- Sex
- Male
- Sole proprietor
- No
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 | 61129517 | WA | Primary |
Addresses
Primary practice location
4001 Main St Ste 200
Vancouver, WA 98663-1894
Mailing address
13518 SE Bush St
Portland, OR 97236-3373
Phone (808) 754-0580
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Western States College of Chiropractic, 2020
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
4001 Main St
Suite 200
Vancouver, WA 98663-1894
Phone (360) 693-3030
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61129517 | WA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| BC Chiropractic Clinic | Chiropractor | Current | Accepting new patients |
Locations
4001 Main St
Ste 200
Vancouver, WA 98663
Phone (360) 693-3030
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609545600000",
"number": "1942898358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13518 SE BUSH ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972363373",
"telephone_number": "808-754-0580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 MAIN ST STE 200",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986631894",
"telephone_number": "360-693-3030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KYLE",
"middle_name": "RICHARD IKAIKA",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-02",
"last_updated": "2021-01-02",
"certification_date": "2021-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WA",
"license": "61129517",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.