Individual provider Active NPI

Judy K Soborowicz, DC

  • Chiropractor
  • Eau Claire, WI
National Provider Identifier
1104883404
Registry record updated Jan 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3103 Issued in WI
Practice address
3521 London Rd
Eau Claire, WI 54701-7861
Phone
(715) 834-6333
Fax
(715) 831-6374
NPI assigned
Apr 28, 2006
Last updated
Jan 25, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 25, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3103 WI Primary

Addresses

Primary practice location

3521 London Rd
Eau Claire, WI 54701-7861

Mailing address

3521 London Rd
Eau Claire, WI 54701-7861

Other identifiers 1

IdentifierTypeStateIssuer
350050962OtherWIRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100927000131 WI Practitioner - Chiropractic 3971629049 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1993
Medicare assignment
May accept Medicare assignment
Group practices
Active Health Eau ClaireGroup PAC ID 2264655182, 3 clinicians

Practice addresses (Care Compare)

3521 London Rd
Suite a
Eau Claire, WI 54701-7861
Phone (715) 834-6333

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3103WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Active Health Eau Claire Chiropractor CurrentSince May 5, 2014 Accepting new patients
Carlson Chiropractic, LLC Chiropractor PastSince Sep 1, 2013 Accepting new patients

Locations

3521 London Rd
Ste A
Eau Claire, WI 54701
Phone (715) 834-6333

3521 London Rd
Eau Claire, WI 54701
Phone (715) 834-6333

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295913600000",
    "number": "1104883404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3521 LONDON RD",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547017861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3521 LONDON RD",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547017861",
            "telephone_number": "715-834-6333",
            "fax_number": "715-831-6374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOBOROWICZ",
        "first_name": "JUDY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-28",
        "last_updated": "2011-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "350050962",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eau Claire, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; 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.