Restore Spine and Wellness LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3623-012 Issued in WI

Legal business name

RESTORE SPINE AND WELLNESS LLC

Practice address

122 Green Bay Rd Ste 100
Thiensville, WI 53092-1679

Phone

(262) 478-9104

Fax

(262) 478-9105

NPI assigned

Nov 20, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Andrew McGuireNPI 1760820005

Title

Owner

Phone

(262) 478-9104

Specialties & licenses 1

Addresses

Other names 1

• Wellness Way Mequon LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew John McGuire, D.C.

  • Chiropractor
  • Thiensville, WI
  • NPI 1760820005
  Medicare reassignment Care Compare group NPD Authorized official
• Austin Gunderson, DC

  • Chiropractor
  • Thiensville, WI
  • NPI 1306435466
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1416441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689638400000",
    "number": "1013314947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 GREEN BAY RD STE 100",
            "city": "THIENSVILLE",
            "state": "WI",
            "postal_code": "530921679",
            "telephone_number": "262-478-9104",
            "fax_number": "262-478-9105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 GREEN BAY RD STE 100",
            "city": "THIENSVILLE",
            "state": "WI",
            "postal_code": "530921679",
            "telephone_number": "262-478-9104",
            "fax_number": "262-478-9105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE SPINE AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-20",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A",
        "authorized_official_last_name": "MCGUIRE",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-478-9104",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3623-012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellness Way Mequon LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• All providers in Thiensville, WI
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; 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.