Organization Active NPI

De Pere Chiropractic Center, LLC

Doing business as De Pere Chiropractic Center

  • Chiropractor
  • De Pere, WI
National Provider Identifier
1083600654
Registry record updated Sep 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
DE PERE CHIROPRACTIC CENTER, LLC
Doing business as
De Pere Chiropractic Center
Practice address
820 George St
De Pere, WI 54115-2916
Phone
(920) 336-2921
Fax
(920) 425-4196
NPI assigned
Sep 20, 2005
Last updated
Sep 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2025

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

Authorized official

Name
Dr. Jaceson L. Hauser, DCNPI 1972788297
Title
Owner
Phone
(920) 336-2921

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X WI Primary

Addresses

Primary practice location

820 George St
De Pere, WI 54115-2916

Mailing address

820 George St
De Pere, WI 54115-2916
Phone (920) 336-2921

Other identifiers 1

IdentifierTypeStateIssuer
38991400MedicaidWI

Other names 1

  • De Pere Chiropractic Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180420000572 WI Part B Supplier - Clinic/Group Practice 8022371236 Receives reassigned benefits from 2 practitioners
Practice locations: De Pere, WI

National Provider Directory

National Provider Directory

Locations

820 George St
De Pere, WI 54115
Phone (920) 336-2921

Practitioners & affiliated clinicians

Practitioners 2

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": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756857600000",
    "number": "1083600654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 GEORGE ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541152916",
            "telephone_number": "920-336-2921",
            "fax_number": "920-425-4196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 GEORGE ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541152916",
            "telephone_number": "920-336-2921",
            "fax_number": "920-425-4196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE PERE CHIROPRACTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-20",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A",
        "authorized_official_last_name": "HAUSER",
        "authorized_official_first_name": "JACESON",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-336-2921",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38991400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "De Pere Chiropractic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in De Pere, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2025; 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.