Organization Active NPI

Chiropractic and Rehab Center LLC

  • Chiropractor
  • Hillsboro, WI
National Provider Identifier
1174092779
Registry record updated Feb 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
CHIROPRACTIC AND REHAB CENTER LLC
Practice address
840 Water Ave
Hillsboro, WI 54634-6213
Phone
(608) 489-4263
NPI assigned
Nov 13, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2019

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

Authorized official

Name
Dr. Brian Miller, DCNPI 1568938371
Title
Doctor of Chiropractic
Phone
(608) 479-1514

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 Primary

Addresses

Primary practice location

840 Water Ave
Hillsboro, WI 54634-6213

Mailing address

W10436 Kratche Rd
Elroy, WI 53929-9701

Other identifiers 1

IdentifierTypeStateIssuer
1568938371MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190220000090 WI Part B Supplier - Clinic/Group Practice 8527306422 Receives reassigned benefits from 2 practitioners
Practice locations: Hillsboro, WI

National Provider Directory

National Provider Directory

Locations

840 Water Ave
Hillsboro, WI 54634
Phone (608) 489-4263

Practitioners & affiliated clinicians

Practitioners 5

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": "1542067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550448000000",
    "number": "1174092779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W10436 KRATCHE RD",
            "city": "ELROY",
            "state": "WI",
            "postal_code": "539299701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 WATER AVE",
            "city": "HILLSBORO",
            "state": "WI",
            "postal_code": "546346213",
            "telephone_number": "608-489-4263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIROPRACTIC AND REHAB CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-13",
        "last_updated": "2019-02-18",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "608-479-1514",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1568938371",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hillsboro, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2019; 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.