Glenn R Wysocki, DC

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

License

1512 Issued in WI

Practice address

7537 22ND Avenue
Kenosha, WI 53143-5701

Phone

(262) 652-3100

Fax

(262) 652-3100

NPI assigned

Feb 27, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 1979

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323388800000",
    "number": "1215064597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7537 22ND AVENUE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435701",
            "telephone_number": "262-652-3100",
            "fax_number": "262-652-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7537 22ND AVENUE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435701",
            "telephone_number": "262-652-3100",
            "fax_number": "262-652-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYSOCKI",
        "first_name": "GLENN",
        "middle_name": "R",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2011-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "1512",
            "primary": false
        },
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "WI",
            "license": "1512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nana Boahene Kwabena Yeboah, D.D.S.

• Orthopedic Chiropractor in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Orthopedic Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.