Wiesztort Family Chiropractic Clinic, S.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3514 Issued in WI

Legal business name

WIESZTORT FAMILY CHIROPRACTIC CLINIC, S.C.

Practice address

4014 77TH St Ste 2
Kenosha, WI 53142-4314

Phone

(262) 694-3530

Fax

(262) 925-8810

NPI assigned

Nov 14, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Walter Rudolph Wiesztort, D.C.NPI 1003814336

Title

President

Phone

(262) 694-3530

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

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

• Walter Rudolph Wiesztort, D.C.

  • Chiropractor
  • Kenosha, WI
  • NPI 1003814336
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1033281167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4014 77TH ST STE 2",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531424314",
            "telephone_number": "262-694-3530",
            "fax_number": "262-925-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4014 77TH ST STE 2",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531424314",
            "telephone_number": "262-694-3530",
            "fax_number": "262-925-8810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIESZTORT FAMILY CHIROPRACTIC CLINIC, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "WIESZTORT",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "RUDOLPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-694-3530",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38911900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rayme White, OTR/L
• Therese Marie Whitt, MD
• Maryann Cathrine Widzins, RN
• Melissa Wiedenhoeft, MS, CF-SLP
• Leesa Marie Wiedholz-Abbott, PSY.D.
• Walter Rudolph Wiesztort, D.C.
• April Brianna Wight, MSW, APSW
• Deana Mechelle Wiley, LPC-IT
• Kendall Wilkes, DMD
• Amy Wilkinson, RN

• Chiropractor in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; 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.