Brian D Dittmann, DC
Individual provider Active NPI Chiropractor · Clinton, WI
NPI 1144381971 · NPPES record last updated Nov 17, 2010
Key facts
- NPI
- 1144381971
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 3029012 (WI)
- Practice address
- 400 Ogden Ave
Clinton, WI 53525-9005 - Phone
- (608) 676-2210
- Fax
- (608) 676-5947
- NPI assigned
- Dec 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
400 Ogden Ave
Clinton, WI 53525-9005
Phone (608) 676-2210
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040506000436 | WI | Practitioner - Chiropractic | 2961490925 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3029012 | WI | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinton Chiropractic Clinic SC | Chiropractor | Current |
Accepting new patients |
Locations
400 Ogden Ave
Clinton, WI 53525
Phone (608) 676-2210
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3029012 | WI | Yes |
Addresses
Primary practice location
400 Ogden Ave
Clinton, WI 53525-9005
Mailing address
400 Ogden Ave
Clinton, WI 53525-9005
Phone (608) 676-2210
Other providers in Clinton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.