Walter Rudolph Wiesztort, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3514-012 Issued in WI

Practice address

4014 77TH St
Ste. 2
Kenosha, WI 53142-4314

Phone

(262) 694-3530

Fax

(262) 925-8810

NPI assigned

Jul 11, 2005

Reactivated

Mar 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Wiesztort Family Chiropractic Clinic, S.C.

  • Chiropractor
  • Kenosha, WI
  • NPI 1033281167
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208822400000",
    "number": "1003814336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4014 77TH ST",
            "address_2": "STE. 2",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531424314",
            "telephone_number": "262-694-3530",
            "fax_number": "262-925-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4014 77TH ST",
            "address_2": "STE. 2",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531424314",
            "telephone_number": "262-694-3530",
            "fax_number": "262-925-8810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESZTORT",
        "first_name": "WALTER",
        "middle_name": "RUDOLPH",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2008-04-22",
        "deactivation_date": "2006-03-16",
        "reactivation_date": "2006-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3514-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38911900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MACS",
            "identifier": "521540114",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "4400259",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0005896742",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0191565",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "721524922010",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Therese Marie Whitt, MD
• Maryann Cathrine Widzins, RN
• Melissa Wiedenhoeft, MS, CF-SLP
• Leesa Marie Wiedholz-Abbott, PSY.D.
• Wiesztort Family Chiropractic Clinic, S.C.
• April Brianna Wight, MSW, APSW
• Deana Mechelle Wiley, LPC-IT
• Kendall Wilkes, DMD
• Amy Wilkinson, RN
• Angela Wilkinson, RN

• Chiropractor in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; 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.