Individual provider Active NPI

William J Lust, D.C.

  • Chiropractor
  • Jefferson, WI
National Provider Identifier
1164533758
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4242-012 Issued in WI
Practice address
109 E Milwaukee St
Jefferson, WI 53549-1635
Phone
(920) 674-6627
Fax
(920) 674-6632
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4242-012 WI Primary

Addresses

Primary practice location

109 E Milwaukee St
Jefferson, WI 53549-1635

Mailing address

1823 Bourbon Rd
Cross Plains, WI 53528-9436
Phone (608) 798-3300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061018000075 WI Practitioner - Chiropractic 6204832017 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mjliechty Health ServicesGroup PAC ID 1759550338, 2 clinicians

Practice addresses (Care Compare)

1823 Bourbon Rd
Cross Plains, WI 53528-9436
Phone (608) 798-3300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4242-012WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Pain Relief Chiropractic Chiropractor CurrentSince Aug 1, 2013 Accepting new patients
Mjliechty Health Services Chiropractor CurrentSince Aug 12, 2021 Accepting new patients
Believe Corporation Chiropractor CurrentSince Aug 8, 2021 Accepting new patients
Chiropractic Care Centers, S.C. Chiropractor PastSince Aug 1, 2013 Accepting new patients
W & P Enterprises Inc Chiropractor PastSince May 15, 2005 Accepting new patients

Locations

1823 Bourbon Rd
Cross Plains, WI 53528
Phone (608) 798-3300

109 E Milwaukee St
Jefferson, WI 53549
Phone (920) 674-6627

Organizations & group practices 5

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1164533758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1823 BOURBON RD",
            "city": "CROSS PLAINS",
            "state": "WI",
            "postal_code": "535289436",
            "telephone_number": "608-798-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 E MILWAUKEE ST",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535491635",
            "telephone_number": "920-674-6627",
            "fax_number": "920-674-6632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUST",
        "first_name": "WILLIAM",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4242-012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; 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.