NPIMap

Organization Active NPI

Gold Medal Group, LLC

  • Chiropractor
  • Green Bay, WI
National Provider Identifier
1114513652
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
GOLD MEDAL GROUP, LLC
Practice address
827 Cormier Rd
Green Bay, WI 54304-4706
Phone
(920) 569-2350
NPI assigned
Dec 18, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

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

Authorized official

Name
Dr. Jackson Draeger, DCNPI 1073012290
Title
Owner
Phone
(920) 569-2350

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 Primary

Addresses

Primary practice location

827 Cormier Rd
Green Bay, WI 54304-4706

Mailing address

827 Cormier Rd
Green Bay, WI 54304-4706
Phone (920) 569-2350

Other names 1

  • Midwest Pain Solutions Doing business as

National Provider Directory

National Provider Directory

Locations

827 Cormier Rd
Green Bay, WI 54304
Phone (920) 569-2350

Practitioners & affiliated clinicians

Practitioners 3

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": "1608249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608249600000",
    "number": "1114513652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "827 CORMIER RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543044706",
            "telephone_number": "920-569-2350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 CORMIER RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543044706",
            "telephone_number": "920-569-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLD MEDAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-18",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A",
        "authorized_official_last_name": "DRAEGER",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-569-2350",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Pain Solutions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 18, 2020; 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.