NPIMap

Organization Active NPI

Black River Chiropractic Center, SC

  • Chiropractor
  • Neillsville, WI
National Provider Identifier
1073514527
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
BLACK RIVER CHIROPRACTIC CENTER, SC
Practice address
154 E 5TH St
Neillsville, WI 54456-1941
Phone
(715) 743-3404
Fax
(715) 743-4449
NPI assigned
Aug 9, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ruth V Jean, DC DABCO
Title
President
Phone
(715) 284-2915

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X WI Primary

Addresses

Primary practice location

154 E 5TH St
Neillsville, WI 54456-1941

Mailing address

126 S 2ND St
Black River Falls, WI 54615-1726
Phone (715) 284-2915

Other identifiers 1

IdentifierTypeStateIssuer
38996500MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Black River Chiropractic Center SC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

154 E 5th St
Neillsville, WI 54456
Phone (715) 743-3404

Practitioners & affiliated clinicians

Practitioners 6

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": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1073514527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 S 2ND ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546151726",
            "telephone_number": "715-284-2915",
            "fax_number": "715-284-7492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 E 5TH ST",
            "city": "NEILLSVILLE",
            "state": "WI",
            "postal_code": "544561941",
            "telephone_number": "715-743-3404",
            "fax_number": "715-743-4449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER CHIROPRACTIC CENTER, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JEAN",
        "authorized_official_first_name": "RUTH",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-284-2915",
        "authorized_official_credential": "DC DABCO"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38996500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Neillsville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.

Verify at the official NPI Registry.