Benjamin John Breidenbach
Individual provider Active NPI Chiropractor · Lacrosse, WI
NPI 1245309327 · NPPES record last updated Sep 27, 2011
Key facts
- NPI
- 1245309327
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 3676012 (WI)
- Practice address
- 1640 George St
Lacrosse, WI 54650 - Phone
- (608) 781-9880
- Fax
- (608) 783-5426
- NPI assigned
- Nov 6, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Breidenbach Family and Sports Chiropractic Inc
Practice addresses (Care Compare)
1526 Rose St
Suite 102
La Crosse, WI 54603-4500
Phone (608) 781-9880
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110112001027 | WI | Practitioner - Chiropractic | 9638250194 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3676012 | WI | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Breidenbach Family and Sports Chiropractic Inc | Chiropractor | Current |
Accepting new patients |
| Back to Health Chiropractic LLC | Chiropractor | Past | Accepting new patients |
Locations
1526 Rose St
Ste 102
La Crosse, WI 54603
Phone (608) 781-9880
1526 Rose St
La Crosse, WI 54603
Phone (608) 317-4644
1605 Losey Blvd S
La Crosse, WI 54601
Phone (608) 788-7880
1526 Rose St
Ste 101
La Crosse, WI 54603
Phone (608) 386-9328
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3676012 | WI | Yes |
Addresses
Primary practice location
1640 George St
Lacrosse, WI 54650
Mailing address
N5498 Hwy 35
Onalaska, WI 54650
Phone (608) 779-5323
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38927000 | Medicaid | WI |
Other providers in Lacrosse, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 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.
- 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.