Blau Chiropractic SC
Organization Active NPI Chiropractor · Portage, WI
NPI 1003003716 · NPPES record last updated Nov 13, 2012
Key facts
- NPI
- 1003003716
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2990 (WI)
- Legal business name
- BLAU CHIROPRACTIC SC
- Practice address
- 641 Latton LN
Portage, WI 53901-1078 - Phone
- (608) 742-1300
- Fax
- (608) 745-0147
- NPI assigned
- Sep 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Kevin A Blau, DC
- Title
- Chiropractor
- Phone
- (608) 742-1300
Practitioners 4
-
Kevin A. Blau, D.C.
-
Jennifer A Breunig, D.C.
-
Chyann Wegner, DC
-
Lance Gary Brisky, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060222000716 | WI | Part B Supplier - Clinic/Group Practice | 2769498104 |
Receives reassigned benefits from 4 practitioners Practice locations: Portage, WI |
National Provider Directory
Locations
641 Latton Ln
Ste A
Portage, WI 53901
Phone (608) 742-1300
641 Latton Ln
Portage, WI 53901
Phone (608) 742-1300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 2990 | WI | Yes |
Addresses
Primary practice location
641 Latton LN
Portage, WI 53901-1078
Mailing address
641 Latton LN
Portage, WI 53901-1078
Phone (608) 742-1300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38887700 | Medicaid | WI |
Other providers in Portage, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.