Active Lifestyle Chiropractic,SC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3391 Issued in WI

Legal business name

ACTIVE LIFESTYLE CHIROPRACTIC,SC

Practice address

140 N. Townline Rd.
Wautoma, WI 54982-0246

Phone

(920) 787-0122

Fax

(920) 787-0091

NPI assigned

Oct 31, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David Michael Gruszka, D.C.NPI 1790871200

Title

Doctor

Phone

(920) 787-0122

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Michael Gruszka, D.C.

  • Chiropractor
  • Wautoma, WI
  • NPI 1790871200
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194801191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 246",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549820246",
            "telephone_number": "920-787-0122",
            "fax_number": "920-787-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 N. TOWNLINE RD.",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549820246",
            "telephone_number": "920-787-0122",
            "fax_number": "920-787-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFESTYLE CHIROPRACTIC,SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRUSZKA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "920-787-0122",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen A Aderhold-Crass, PT
• Thomas C Aldridge, DDS
• Fozia Sarwar Alvi, MD
• Tanya M Amos, MS, LPC
• Erika Renae Anna, RDN, CD

• Chiropractor in Wautoma, WI
• Providers in Wautoma, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.