River Shores Chiropractic SC
Organization Active NPI Chiropractor · West Bend, WI
NPI 1013197904 · NPPES record last updated Nov 7, 2007
Key facts
- NPI
- 1013197904
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4353-12 (WI)
- Legal business name
- RIVER SHORES CHIROPRACTIC SC
- Practice address
- 705 Village Green Way
Suite 105
West Bend, WI 53090-2527 - Phone
- (262) 334-4070
- Fax
- (262) 334-4078
- NPI assigned
- Nov 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Krysti K. Wick, D.C.
- Title
- Owner/Chiropractor
- Phone
- (262) 573-4465
Practitioners 10
-
Rhyann Deline, DC
-
Krysti K Wick, D.C.
-
Madison Jumper, DC
-
Trista M Bringa, D.C.
-
Linda Dehnert, D.C.
-
Thomas J Friedemann, D.C.
-
Angela Guerra, L.A.C.
-
Patrick James McCann, D.C.
-
Breyan Michelle Radeck, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071215000098 | WI | Part B Supplier - Clinic/Group Practice | 3173613072 |
Receives reassigned benefits from 2 practitioners Practice locations: West Bend, WI |
National Provider Directory
Locations
235 N 18th Ave
West Bend, WI 53095
Phone (262) 334-0374
705 Village Green Way
Ste 105
West Bend, WI 53090
Phone (262) 334-1011
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 4353-12 | WI | Yes |
Addresses
Primary practice location
705 Village Green Way
Suite 105
West Bend, WI 53090-2527
Mailing address
705 Village Green Way
Suite 105
West Bend, WI 53090-2527
Phone (262) 334-4070
Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.