NPIMap

Organization Active NPI

The Wellness Way Green Bay LLC

  • Chiropractor
  • Green Bay, WI
National Provider Identifier
1003837170
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3623012 Issued in WI
Legal business name
THE WELLNESS WAY GREEN BAY LLC
Practice address
2525 W Mason St
Green Bay, WI 54303-4838
Phone
(920) 429-2844
Fax
(920) 429-2845
NPI assigned
Jul 22, 2006
Last updated
Dec 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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

Authorized official

Name
Dr. Patrick M Flynn, D.C.NPI 1366477341
Title
Owner
Phone
(920) 429-2844

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 3623012 WI Primary

Addresses

Primary practice location

2525 W Mason St
Green Bay, WI 54303-4838

Mailing address

2525 W Mason St
Green Bay, WI 54303-4838
Phone (920) 429-2844

Other identifiers 1

IdentifierTypeStateIssuer
100005820MedicaidWI

Other names 1

  • Flynns Children & Fam Chiro Ctr LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050330001089 WI Part B Supplier - Clinic/Group Practice 4284680463 Receives reassigned benefits from 6 practitioners
Practice locations: Green Bay, WI

National Provider Directory

National Provider Directory

Locations

2525 W Mason St
Green Bay, WI 54303
Phone (920) 429-2844

746 N Memorial Dr
Green Bay, WI 54303
Phone (920) 429-2844

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609286400000",
    "number": "1003837170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034838",
            "telephone_number": "920-429-2844",
            "fax_number": "920-429-2845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034838",
            "telephone_number": "920-429-2844",
            "fax_number": "920-429-2845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WELLNESS WAY GREEN BAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A",
        "authorized_official_last_name": "FLYNN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-429-2844",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3623012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100005820",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Flynns Children & Fam Chiro Ctr LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Flynns Children & Fam Chiro Ctr LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.