Mickey A Fuson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038004294 Issued in IL

Practice address

2415 E Washington St
Suite F
Bloomington, IL 61704-4473

Phone

(309) 838-7011

NPI assigned

Jul 16, 2012

Sex

Male

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342396800000",
    "number": "1992050074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 E WASHINGTON ST STE F",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617041609",
            "telephone_number": "309-838-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 E WASHINGTON ST",
            "address_2": "SUITE F",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617044473",
            "telephone_number": "309-838-7011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUSON",
        "first_name": "MICKEY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-16",
        "last_updated": "2012-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038004294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Chiropractor in Illinois

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

Verify at the official NPI Registry.