NPIMap

Organization Active NPI

Procare Chiropractic Clinic LTD

  • Chiropractor
  • Green Bay, WI
National Provider Identifier
1023229903
Registry record updated Mar 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1451 Issued in WI
Legal business name
PROCARE CHIROPRACTIC CLINIC LTD
Practice address
940 Hansen Rd
Ste F
Green Bay, WI 54304-5377
Phone
(920) 496-6000
Fax
(920) 496-0998
NPI assigned
May 24, 2007
Last updated
Mar 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2012

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

Authorized official

Name
Dr. Ray Roddan, DCNPI 1215011176
Title
President
Phone
(920) 496-6000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1451 WI Primary

Addresses

Primary practice location

940 Hansen Rd
Ste F
Green Bay, WI 54304-5377

Mailing address

940 Hansen Rd
Ste F
Green Bay, WI 54304-5377
Phone (920) 496-6000

Other identifiers 1

IdentifierTypeStateIssuer
3980300MedicaidWI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330905600000",
    "number": "1023229903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 HANSEN RD",
            "address_2": "STE F",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045377",
            "telephone_number": "920-496-6000",
            "fax_number": "920-496-0998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 HANSEN RD",
            "address_2": "STE F",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045377",
            "telephone_number": "920-496-6000",
            "fax_number": "920-496-0998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROCARE CHIROPRACTIC CLINIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2012-03-05",
        "status": "A",
        "authorized_official_last_name": "RODDAN",
        "authorized_official_first_name": "RAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-496-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "1451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3980300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Mar 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.