NPIMap

Organization Active NPI

Waupaca Chiropractic Center, Inc

  • Chiropractor
  • Waupaca, WI
National Provider Identifier
1124194790
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3651 Issued in WI
Legal business name
WAUPACA CHIROPRACTIC CENTER, INC
Practice address
304 S Western Ave
Waupaca, WI 54981-5703
Phone
(715) 258-8211
NPI assigned
Nov 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Miriam Leean-Rodenz, DC
Title
President
Phone
(715) 258-8211

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3651 WI Primary

Addresses

Primary practice location

304 S Western Ave
Waupaca, WI 54981-5703

Mailing address

304 S Western Ave
Waupaca, WI 54981-5703
Phone (715) 258-8211

Other identifiers 1

IdentifierTypeStateIssuer
38934000MedicaidWI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124194790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 S WESTERN AVE",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549815703",
            "telephone_number": "715-258-8211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 S WESTERN AVE",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549815703",
            "telephone_number": "715-258-8211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUPACA CHIROPRACTIC CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEEAN-RODENZ",
        "authorized_official_first_name": "MIRIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-258-8211",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38934000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waupaca, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.