Chiropractic Care Center-Waukesha,LLC
Organization Active NPI Chiropractor · Greendale, WI
NPI 1063693166 · NPPES record last updated Aug 15, 2014
Key facts
- NPI
- 1063693166
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 3572 (WI)
- Legal business name
- CHIROPRACTIC CARE CENTER-WAUKESHA,LLC
- Practice address
- 6400 Industrial Loop
Greendale, WI 53129-2452 - Phone
- (414) 423-4100
- Fax
- (414) 423-4134
- NPI assigned
- Nov 16, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Laura A Dull, DC
- Title
- Chiropractor
- Phone
- (262) 542-9814
Practitioners 2
-
Ethan A. Dull, D.C.
-
Laura Ann Dull, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080125000695 | WI | Part B Supplier - Clinic/Group Practice | 4183706344 |
Receives reassigned benefits from 2 practitioners Practice locations: Waukesha, WI |
National Provider Directory
Locations
811 N Grandview Blvd
Ste A
Waukesha, WI 53188
Phone (262) 542-9814
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 3572 | WI | Yes |
Addresses
Primary practice location
6400 Industrial Loop
Greendale, WI 53129-2452
Mailing address
811 N Grandview Blvd
Waukesha, WI 53188-2894
Phone (262) 542-9814
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38920300 | Medicaid | WI |
Other providers in Greendale, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2014. 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.