NPIMap

Organization Active NPI

Parkside Chiropractic LTD

  • Chiropractor
  • Columbus, WI
National Provider Identifier
1205867538
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
70901-012 Issued in WI
Legal business name
PARKSIDE CHIROPRACTIC LTD
Practice address
1235 Park Ave
Columbus, WI 53925-1612
Phone
(920) 623-2610
NPI assigned
Jul 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Timothy C Kirchberg, D.C.NPI 1558337568
Title
Chiropractor
Phone
(920) 623-2610

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 70901-012 WI Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 70902-012 WI
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 3989-012 WI

Addresses

Primary practice location

1235 Park Ave
Columbus, WI 53925-1612

Mailing address

1235 Park Ave
Columbus, WI 53925-1612
Phone (920) 623-2610

Other identifiers 1

IdentifierTypeStateIssuer
U43434MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060711000039 WI Part B Supplier - Clinic/Group Practice 6204849433 Receives reassigned benefits from 3 practitioners
Practice locations: Columbus, WI

National Provider Directory

National Provider Directory

Locations

1235 Park Ave
Columbus, WI 53925
Phone (920) 623-2610

Practitioners & affiliated clinicians

Practitioners 4

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": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205867538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539251612",
            "telephone_number": "920-623-2610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539251612",
            "telephone_number": "920-623-2610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKSIDE CHIROPRACTIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIRCHBERG",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "920-623-2610",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "70901-012",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "70902-012",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3989-012",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "U43434",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, WI

Sources for this page

  • 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.