Dale R Alt, DC – Chiropractor in Beaver Dam, WI

Key facts

NPI: 1003845587
Entity type: Individual (NPI type 1)
Primary specialty: Chiropractor 111N00000X
License: 2007 (WI)
Practice address: 127 Park Ave
Beaver Dam, WI 53916-2107
Phone: (920) 887-3717
Fax: (920) 887-0220
NPI assigned: Jun 30, 2006
Sex: Male
Sole proprietor: No

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.

Dale R. Alt, D.C., S.C. Chiropractor · Beaver Dam, WI · NPI 1285700955

Medicare reassignment NPD Authorized official CHIROPRACTOR · WI

Medicare Care Compare profile

Specialty: Chiropractic
Also: Diagnostic Radiology
Education: Palmer College Chiropractic - Davenport, 1985
Medicare assignment: Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

127 Park Ave
Beaver Dam, WI 53916-2107
Phone (920) 887-3717

Medicare participation

Medicare fee-for-service enrollment: Enrolled in WI
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20111212000668	WI	Practitioner - Chiropractic Practitioner - Diagnostic Radiology	4587839063	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): No
HHS exclusion list flag: The National Provider Directory flags this NPI as appearing on an HHS exclusion list. Confirm with the OIG exclusions search.

Practice roles

Organization	Specialty	Status	New patients
Dale R. Alt, D.C., S.C.	Chiropractor	Current since Dec 12, 2011	Accepting new patients

Locations

127 Park Ave
Beaver Dam, WI 53916
Phone (414) 887-3717

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Chiropractor	111N00000X	2007	WI	Yes

Addresses

Primary practice location

127 Park Ave
Beaver Dam, WI 53916-2107

Mailing address

127 Park Ave
Beaver Dam, WI 53916-2107
Phone (920) 887-3717

Other identifiers

Identifier	Type	State	Issuer
38833700	Medicaid	WI

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003845587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 PARK AVE",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162107",
            "telephone_number": "920-887-3717",
            "fax_number": "920-887-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 PARK AVE",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162107",
            "telephone_number": "920-887-3717",
            "fax_number": "920-887-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALT",
        "first_name": "DALE",
        "middle_name": "R",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "2007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38833700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver Dam, WI

All providers in Beaver Dam, WI · Chiropractor in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.
Order and Referring (CMS).
Medicare Care Compare provider data (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.