Individual provider Active NPI

Richard Charles Maedke, D.C.

  • Chiropractor
  • Shorewood, WI
National Provider Identifier
1124176268
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2789-012 Issued in WI
Practice address
1410 E Capitol Dr
Shorewood, WI 53211-1901
Phone
(414) 906-8081
Fax
(414) 906-8093
NPI assigned
Jan 8, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2789-012 WI Primary

Addresses

Primary practice location

1410 E Capitol Dr
Shorewood, WI 53211-1901

Mailing address

4228 N Woodburn St
Shorewood, WI 53211-1503
Phone (414) 964-1685

Other identifiers 1

IdentifierTypeStateIssuer
38866900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
2789-012WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Chiropractic Care Centers, S.C. Chiropractor Past Accepting new patients
Anne Maedke, DC Dabci Chiropractor Past Accepting new patients
Chiropractic Company - Milwaukee East LTD. Chiropractor PastSince Mar 1, 2011 Accepting new patients
Riverwest Chiropractic Center LLC Chiropractor Past Accepting new patients

Organizations & group practices 4

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": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124176268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4228 N WOODBURN ST",
            "city": "SHOREWOOD",
            "state": "WI",
            "postal_code": "532111503",
            "telephone_number": "414-964-1685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 E CAPITOL DR",
            "city": "SHOREWOOD",
            "state": "WI",
            "postal_code": "532111901",
            "telephone_number": "414-906-8081",
            "fax_number": "414-906-8093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAEDKE",
        "first_name": "RICHARD",
        "middle_name": "CHARLES",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "2789-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38866900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shorewood, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.