David Mark Washa, DC
Individual provider Active NPI Sports Physician Chiropractor · Lacrosse, WI
NPI 1164580031 · NPPES record last updated May 22, 2008
Key facts
- NPI
- 1164580031
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Physician Chiropractor 111NS0005X
- License
- 2535 (WI)
- Practice address
- 1415 US Hwy 16
Lacrosse, WI 54601 - Phone
- (608) 785-7746
- Fax
- (608) 782-2938
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1415 Hwy 16
La Crosse, WI 54601-2980
Phone (608) 785-7746
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080502000369 | WI | Practitioner - Chiropractic | 7315026275 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2535 | WI | MD | Sports Physician Chiropractor |
| 2813 | MN | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Washa Chiropractic Clinic, Inc. | Sports Physician | Current |
Accepting new patients |
Locations
1415 Wi 16
La Crosse, WI 54601
Phone (608) 785-7746
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 2535 | WI | Yes |
| Sports Physician Chiropractor | 111NS0005X | 2813 | MN |
Addresses
Primary practice location
1415 US Hwy 16
Lacrosse, WI 54601
Mailing address
1415 US Hwy 16
Lacrosse, WI 54601
Phone (608) 785-7746
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 279J7WA | Other | MN | BLUE CROSS BLUE SHIELD |
| 391762498 | Other | WI | FED TAX |
| 391762498015 | Other | WI | BLUE CROSS BLUE SHIELD |
| P00046865 | Other | RAILROAD MEDICARE |
Other providers in Lacrosse, WI
- Patricia A Seubert
- Heather Maria Stahl
- Renee F Thies
- Three Rivers Chiropractic LLC
- Ralph W Tyler
- Susan J Watkins
- Mary C Wente
- Ann Marie Wonderling
- Katelynn Dora Wussow
- Jay Michael Yahnke
All providers in Lacrosse, WI · Sports Physician Chiropractor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2008. 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.