Michael David Berglund, D.C. – Chiropractor

Key facts

NPI: 1235247693
Entity type: Individual (NPI type 1)
Primary specialty: Chiropractor 111N00000X
License: 2671 (WI)
Practice address: 5027 Green Bay Rd
Ste 118
Kenosha, WI 53144-1771
Phone: (262) 925-8600
Fax: (292) 925-8599
NPI assigned: Aug 27, 2006
Sex: Male
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Berglund Chiropractic Clinic SC Primary Care Clinic/Center · Kenosha, WI · NPI 1669682282

Medicare reassignment NPD Authorized official WI
Baertlein Chiropractic LLC Chiropractor · Racine, WI · NPI 1891909503

NPD (past) CHIROPRACTOR

Medicare Care Compare profile

Specialty: Chiropractic
Education: National College of Chiropractic, 1990
Medicare assignment: Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5027 Green Bay Rd
Kenosha, WI 53144-1771
Phone (262) 925-8600

Medicare participation

Medicare fee-for-service enrollment: Enrolled in WI

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20120606000024	WI	Practitioner - Chiropractic	6002863529	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
2671	WI	MD	Physician Assistant

Practice roles

Organization	Specialty	Status	New patients
Berglund Chiropractic Clinic SC		Current since Sep 12, 2001	Accepting new patients
Baertlein Chiropractic LLC	Chiropractor	Past since May 21, 2007	Accepting new patients

Locations

5027 Green Bay Rd
Ste 118
Kenosha, WI 53144
Phone (262) 925-8600

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Chiropractor	111N00000X	2671	WI	Yes

Addresses

Primary practice location

5027 Green Bay Rd
Ste 118
Kenosha, WI 53144-1771

Mailing address

5027 Green Bay Rd
Ste 118
Kenosha, WI 53144-1771
Phone (262) 925-8600

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 15, 2007.

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195084800000",
    "number": "1235247693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5027 GREEN BAY RD",
            "address_2": "STE 118",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441771",
            "telephone_number": "262-925-8600",
            "fax_number": "292-925-8599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5027 GREEN BAY RD",
            "address_2": "STE 118",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441771",
            "telephone_number": "262-925-8600",
            "fax_number": "292-925-8599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGLUND",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-27",
        "last_updated": "2007-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "2671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

All providers in Kenosha, WI · Chiropractor in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2007. 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.
Medicare Care Compare provider data (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.