NPIMap

Organization Active NPI

Shell Lake Cumberland Chiropractic Clinics LLC

  • Chiropractor
  • Shell Lake, WI
National Provider Identifier
1104014059
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3069 Issued in WI
Legal business name
SHELL LAKE CUMBERLAND CHIROPRACTIC CLINICS LLC
Practice address
17 5TH Ave
Shell Lake, WI 54871
Phone
(715) 468-2275
NPI assigned
Oct 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

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

Authorized official

Name
Brenda Reidt, DC
Title
Manager
Phone
(715) 468-2275

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3069 WI Primary

Addresses

Primary practice location

17 5TH Ave
Shell Lake, WI 54871

Mailing address

PO Box 637
Shell Lake, WI 54871
Phone (715) 468-2275

Other identifiers 1

IdentifierTypeStateIssuer
70330OtherMEDICARE GROUP NUMBER

Other names 1

  • Jimmy A Reidt Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610496000000",
    "number": "1104014059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 637",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "54871",
            "telephone_number": "715-468-2275",
            "fax_number": "715-468-4417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 5TH AVE",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "54871",
            "telephone_number": "715-468-2275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELL LAKE CUMBERLAND CHIROPRACTIC CLINICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A",
        "authorized_official_last_name": "REIDT",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "715-468-2275",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "70330",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jimmy A Reidt",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Jimmy A Reidt",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Shell Lake, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; 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.