Individual provider Active NPI

Ryan Michael Tachick, DC

  • Chiropractor
  • Green Bay, WI
National Provider Identifier
1104453570
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5530-12 Issued in WI
Practice address
2530 Lineville Rd Ste 1
Green Bay, WI 54313-8861
Phone
(920) 857-3126
NPI assigned
Mar 25, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5530-12 WI Primary

Addresses

Primary practice location

2530 Lineville Rd Ste 1
Green Bay, WI 54313-8861

Mailing address

3446 Jersey LN
Suamico, WI 54313-3624
Phone (920) 660-6081

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200515002173 WI Practitioner - Chiropractic 4880025329 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Health in Motion Chiropractic LLCGroup PAC ID 0345671889, 2 clinicians

Practice addresses (Care Compare)

2530 Lineville Rd
Suite 1
Green Bay, WI 54313-8861
Phone (920) 857-3126

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5530-12WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Health in Motion Chiropractic LLC Chiropractor CurrentSince May 1, 2020 Accepting new patients
Health in Motion Rehab Services CurrentSince Sep 1, 2022 Accepting new patients

Locations

2530 Lineville Rd
Ste 1
Green Bay, WI 54313
Phone (920) 857-3126

11880 Velp Ave
Ste F
Suamico, WI 54313
Phone (920) 660-6081

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1585094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1104453570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3446 JERSEY LN",
            "city": "SUAMICO",
            "state": "WI",
            "postal_code": "543133624",
            "telephone_number": "920-660-6081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 LINEVILLE RD STE 1",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543138861",
            "telephone_number": "920-857-3126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACHICK",
        "first_name": "RYAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-25",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "5530-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.