Organization Active NPI

Van Drisse Chiropractic Center LLC

  • Chiropractor
  • De Pere, WI
National Provider Identifier
1194913434
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3145-012 Issued in WI
Legal business name
VAN DRISSE CHIROPRACTIC CENTER LLC
Practice address
502 George St
De Pere, WI 54115-2772
Phone
(920) 337-0103
Fax
(920) 338-9066
NPI assigned
Oct 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Authorized official

Name
Dr. David M Van Drisse, D.C.NPI 1386743797
Title
Owner
Phone
(920) 337-0103

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 3145-012 WI Primary

Addresses

Primary practice location

502 George St
De Pere, WI 54115-2772

Mailing address

502 George St
De Pere, WI 54115-2772
Phone (920) 337-0103

Other identifiers 1

IdentifierTypeStateIssuer
38921100MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060410000017 WI Part B Supplier - Clinic/Group Practice 8921017682 Receives reassigned benefits from 4 practitioners
Practice locations: De Pere, WI

National Provider Directory

National Provider Directory

Locations

502 George St
De Pere, WI 54115
Phone (920) 337-0103

502 George St
#A
De Pere, WI 54115
Phone (920) 337-0103

Practitioners & affiliated clinicians

Practitioners 8

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": "1192060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756944000000",
    "number": "1194913434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 GEORGE ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541152772",
            "telephone_number": "920-337-0103",
            "fax_number": "920-338-9066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 GEORGE ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541152772",
            "telephone_number": "920-337-0103",
            "fax_number": "920-338-9066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN DRISSE CHIROPRACTIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-11",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A",
        "authorized_official_last_name": "VAN DRISSE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-337-0103",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3145-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38921100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in De Pere, WI

Sources for this page

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