Individual provider Active NPI

Anthony F Wissbroecker, D.C.

  • Chiropractor
  • Owatonna, MN
National Provider Identifier
1265844740
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5955 Issued in MN
Practice address
685 W Bridge St Ste 7
Owatonna, MN 55060-2888
Phone
(507) 413-8300
Fax
(507) 413-8301
NPI assigned
Jun 2, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5955 MN Primary

Addresses

Primary practice location

685 W Bridge St Ste 7
Owatonna, MN 55060-2888

Mailing address

685 W Bridge St Ste 7
Owatonna, MN 55060-2888
Phone (507) 413-8300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200210000501 MN Practitioner - Chiropractic 7012343197 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

685 W Bridge St
Suite 7
Owatonna, MN 55060-2888
Phone (507) 413-8300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5955MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Wellfit Chiropractic LLC Chiropractor CurrentSince Jan 31, 2020 Accepting new patients

Locations

685 W Bridge St
Ste 7
Owatonna, MN 55060
Phone (507) 413-8300

685 W Bridge St
Ste 1B
Owatonna, MN 55060
Phone (507) 413-8300

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646784000000",
    "number": "1265844740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 W BRIDGE ST STE 7",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550602888",
            "telephone_number": "507-413-8300",
            "fax_number": "507-413-8301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "685 W BRIDGE ST STE 7",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550602888",
            "telephone_number": "507-413-8300",
            "fax_number": "507-413-8301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISSBROECKER",
        "first_name": "ANTHONY",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-02",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Owatonna, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; 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.