Organization Active NPI

Johnson Chiropractic Clinic LLC

  • Chiropractor
  • Portage, WI
National Provider Identifier
1164940581
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4844 Issued in WI
Legal business name
JOHNSON CHIROPRACTIC CLINIC LLC
Practice address
1512 New Pinery Rd
Portage, WI 53901-1312
Phone
(608) 742-5578
Fax
(608) 742-7028
NPI assigned
Sep 6, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Authorized official

Name
Dr. Sydney M Schmus, DCNPI 1477824738
Title
Chiropractor
Phone
(608) 742-5578

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 4844 WI Primary

Addresses

Primary practice location

1512 New Pinery Rd
Portage, WI 53901-1312

Mailing address

1512 New Pinery Rd
Portage, WI 53901-1312
Phone (608) 472-5578

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180102002007 WI Part B Supplier - Clinic/Group Practice 1456619055 Receives reassigned benefits from 2 practitioners
Practice locations: Portage, WI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1504656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1164940581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 NEW PINERY RD",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539011312",
            "telephone_number": "608-472-5578",
            "fax_number": "608-742-7028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 NEW PINERY RD",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539011312",
            "telephone_number": "608-742-5578",
            "fax_number": "608-742-7028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON CHIROPRACTIC CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-06",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "SCHMUS",
        "authorized_official_first_name": "SYDNEY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "608-742-5578",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.