Individual provider Active NPI

Matthew James Wunderlich, D.C.

  • Chiropractor
  • Madison, WI
National Provider Identifier
1265525430
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3965012 Issued in WI
Practice address
3070 Fish Hatchery Rd.
Madison, WI 53713
Phone
(608) 274-2266
Fax
(608) 274-1945
NPI assigned
Oct 2, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3965012 WI Primary

Addresses

Primary practice location

3070 Fish Hatchery Rd.
Madison, WI 53713

Mailing address

3070 Fish Hatchery Rd.
Madison, WI 53713
Phone (608) 274-2266

Other identifiers 1

IdentifierTypeStateIssuer
38982700MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031120000526 WI Practitioner - Chiropractic 5698679835 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2940 Chapel Valley Rd
Suite 3
Fitchburg, WI 53711-6451
Phone (608) 274-7660

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3965012WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Wunderlich Chiropractic LLC Chiropractor CurrentSince Aug 24, 2010 Accepting new patients
The Utschig Group, LTD. Chiropractor Past Accepting new patients

Locations

2940 Chapel Valley Rd
Ste 3
Fitchburg, WI 53711
Phone (608) 274-7660

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265525430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3070 FISH HATCHERY RD.",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "53713",
            "telephone_number": "608-274-2266",
            "fax_number": "608-274-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3070 FISH HATCHERY RD.",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "53713",
            "telephone_number": "608-274-2266",
            "fax_number": "608-274-1945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WUNDERLICH",
        "first_name": "MATTHEW",
        "middle_name": "JAMES",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3965012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38982700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.