Active NPI
Nicholas Agen
- Chiropractor
- Brookfield, WI
National Provider Identifier
1013669746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5715-12
- Practice address
- 17585 Golf Pkwy
Brookfield, WI 53045-2948 - Phone
- (262) 899-7158
- NPI assigned
- Jan 24, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5715-12 | WI | Primary |
Addresses
Primary practice location
17585 Golf Pkwy
Brookfield, WI 53045-2948
Mailing address
17585 Golf Pkwy
Brookfield, WI 53045-2948
Phone (262) 899-7158
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295378875 | Medicaid | WI |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dragen@lifeclinics.life | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643155200000",
"number": "1013669746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17585 GOLF PKWY",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530452948",
"telephone_number": "262-899-7158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17585 GOLF PKWY",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530452948",
"telephone_number": "262-899-7158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGEN",
"first_name": "NICHOLAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-01-24",
"last_updated": "2022-01-26",
"certification_date": "2022-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "5715-12",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1295378875",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "dragen@lifeclinics.life",
"affiliation": "N",
"endpointDescription": "email",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "17585 Golf Pkwy",
"city": "Brookfield",
"state": "WI",
"country_code": "US",
"postal_code": "530452948",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Brookfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.