Gundlach Chiropractic, SC
Organization Active NPI Chiropractor · Ripon, WI
NPI 1225313422 · NPPES record last updated Oct 19, 2011
Key facts
- NPI
- 1225313422
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2307-012 (WI)
- Legal business name
- GUNDLACH CHIROPRACTIC, SC
- Practice address
- 315 Mount Zion Dr
Ripon, WI 54971-1713 - Phone
- (920) 745-3020
- NPI assigned
- Oct 19, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. Roger Oscar Gundlach, D.C.
- Title
- President
- Phone
- (920) 745-3020
Practitioners 1
-
Roger Oscar Gundlach, D.C,
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120103000319 | WI | Part B Supplier - Clinic/Group Practice | 0244406817 |
Receives reassigned benefits from 1 practitioner Practice locations: Ripon, WI |
National Provider Directory
Locations
315 Mount Zion Dr
Ripon, WI 54971
Phone (920) 745-3020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 2307-012 | WI | Yes |
Addresses
Primary practice location
315 Mount Zion Dr
Ripon, WI 54971-1713
Mailing address
315 Mount Zion Dr
Ripon, WI 54971-1713
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38842600 | Medicaid | WI |
Other providers in Ripon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.